[Extended tricuspid valve excision for active infective endocarditis associated with ventricular septal defect]

We report a patient of ventricular septal defect associated with a vegetations on the tricuspid valve and a perforation of the aortic cusp caused by infective endocarditis. Antibiotics could not relieve the high fever of this patient, and disseminated intravascular coagulation caused by sepsis and two-sided heart failure developed. She underwent extended tricuspid valve excision, aortic valve replacement and VSD closure during the active stage. Post-operative antibiotic therapy was continued intravenously for 6 weeks, and orally for 3 more weeks. Although post-operative right ventriculography indicated tricuspid regurgitation and right atrium enlargement, pressure study of the right side of the heart revealed normal hemodynamics.