Bivalvular endocarditis complicating pregnancy. A case report and literature review

A twenty-nine-year old woman with a history of rheumatic fever and both mitral and tricuspid valve prolapse (without cardiac effects on the echocardiogram) presented with Streptococcus viridans infective endocarditis of both the tricuspid and mitral valves at seventeen weeks' gestation. Twelve weeks before admission she underwent a dental curettage and received presumably adequate antibiotic prophylaxis. The present case was successfully managed by means of aggressive antibiotic therapy appropriate for endocarditis, with adequate and appropriate monitoring of minimal inhibitory concentration and peak and trough levels. This case exhibits the appropriate management in the three phases of therapy for valvular disease, ie prevention, treatment, and subsequent prevention of sequelae, prior to vaginal delivery in a patient with endocarditis. The pregnancy resulted in a term vaginal delivery, without maternal or fetal morbidity.