Isolated Pulmonary Valve Endocarditis Leading To Right Ventr
Infective endocarditis involving right side of the heart is uncommon and isolated involvement of pulmonary valve is even rare. It is highly unusual in patients with no apparent precipitating factors like intravenous drug use, congenital heart disease or valvular abnormalities. We describe a case of 37-year-old male who presented with very large vegetation on pulmonary valve leading to right ventricular outflow tract obstruction.

Case Report
A 37-year-old African-American male with significant medical history of diabetes mellitus and recent tooth infection was admitted to hospital for fever and worsening shortness of breath. He had elevated jugular venous distention and bilateral lower extremity edema on clinical examination. The chest X-ray and CT scan was consistent with multiple bilateral cavitary lesions in the lungs. His blood cultures grew staphylococcus aureus (MSSA). Trans-esophageal echocardiogram revealed a big mobile mass on the pulmonary valve causing complete right ventricular outflow tract obstruction. The mass was resected and surgical pathology was positive for acute inflammation with numerous gram-positive cocci consistent with staphylococcal endocarditis. Patient’s clinical status significantly improved after surgery and 6 week coarse of intravenous cefazolin.

Isolated pulmonary valve involvement in infective endocarditis is rare and occurs only in 1-2 % of patients. It usually occurs in presence of certain risk factors, intravenous drug abuse being the important one. Our patient presented with big vegetation on the pulmonary valve causing near total right ventricular outflow tract and signs of right heart failure. Although uncommon but pulmonary valve endocarditis should be kept in mind even in low risk patients presenting with right heart failure....