Right-sided endocarditis involving both tricuspid and pulmonary valves in a patient with ventricular septal defect

A patient with alpha-haemolytic streptococcus endocarditis on a ventricular septal defect is described. The disease spread to involve both tricuspid and pulmonary valves which were largely destroyed. The patient developed severe right heart failure with pronounced rise in right atrial pressure. This led to right-to-left shunting through the foramen ovale with systemic embolization. She was successfully treated by operative closure of the defects and double right-sided valve replacement.