Ebru Özgür TEKBAŞ, Faruk HÖKENEK, M. Sıddık EVSEN, Zuhal Arıtürk ATILGAN, Celal YAVUZ

Doğal triküspit kapak endokarditinin nadir bir nedeni: Düşük

Gebeliğinin 7. Haftasında olan 28 yaşındaki kadın hasta karın ağrısı ve vajinal kanama şikâyetiyle baş-vurduğu başka bir merkezde spontan komplet abortus tanısıyla yatarak tedavi edilmiştir. Takip eden sü-reçte ateş, üşüme, titreme ve halsizlik yakınmalarının ortaya çıkmasıyla tekrar aynı merkeze başvurmuş. Hastaya bu kez nonspesifik antibiyotik tedavisi uygulanmış. Ancak şikâyetlerinin devam etmesi nedeniyle kliniğimize sevk edilmişti. Yapılan transtorasik ekokardiyografide triküspit kapakta vejetasyon saptanması üzerine infektif endokardit tanısı konarak, kliniğimizde tedavisine başlandı. Kan kültürlerinde üreme olma-dı. Takip eden süreçte 15 günlük antibiyotik tedavisine rağmen vejetasyon çapının küçülmemesi üzerine operasyon kararı alındı ve triküspit kapağa biyoprotez uygulandı. Bu makalede gebeliğin 7. haftasında gelişen spontan abortus sonrası triküspit kapak infektif endokarditi olgusu sunularak, triküspit kapak endokarditinin çok nadir görülen nedenlerle de gelişebileceğini vurgulamayı amaçladık

A rare cause of native tricuspid valve endocarditis: Abortus

A 28-year-old female patient, who at her 7 weeks of pregnancy, admitted to hospital with abdominal pain and vaginal bleeding. She had been hospitalized in another center with the diagnosis of spontaneous complete abortion. After discharge, her clinical process, deteriorated due to fever, chills and fatigue there-fore she had been admitted to emergency unit of that hospital once again, and received non-specific anti-biotics. She was referred to our clinic because of persistant complaints. Transthoracic echocardiography showed vegetations on the tricuspid valve leading to diagnosis of infective endocarditis, so treatment was started at our clinic. No microorganism isolated in blood cultures. Following 15-days antibiotic therapy no reduction was seen in the diameter of the vegetation, therefore surgical operation was planned and a bio-prosthetic tricuspid valve was put into place. In this article we aimed to report the development of sponta-neous abortus at 7 weeks of pregnancy, in order to emphasize that tricuspid valve endocarditis can be developed secondary to very rare causes.

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1. Frontera JA, Gradon JD. Right-side endocarditis in injection drug users: review of proposed mechanisms of pathogenesis. Clin Infect Dis 2000;30:374–379.
2. Wilson LE, Thomas DL, Astemborski J, Freedman TL, Vlahov D. Prospective study of infective endocarditis among injection drug users. J Infect Dis 2002;185:1761–1766.
3. Miro JM, del Rio A, Mestres CA. Infective endocarditis and cardiac surgery in intravenous drug abusers and HIV-1 infected patients. Cardiol Clin 2003;21: 167–184.
4. Seaworth BJ, Durack DT Infective endocarditis in obstetric and gynecologic practice. Am J Obsret Gynecoll986; 154: 180–1 88
5. Ward H: Bacterial endocarditis in pregnancy. Aust N Z J ObstetGynaecol 1997;ll: 189–191
6. Wilson W, Taubert KA, Gewitz M, et al: Prevention of in
fective endocarditis recommendations by the American Heart Association. A guideline from the American Heart Association Rheumatic Fever, Endocarditis, Kawasaki Disease Committee, Council on Cardiovascular Disease in the Young and the Council on Clinical Cardiology, Council on Cardiovascular Surgery and Anesthesia and the Quality of Care and Outcomes Research Interdisciplinary Working Group, Circulation 2007 9;116:1736-1754.
7. Bansal, RC. Infective endocarditis. Med Clin North Am 1995; 995;79:1205-1240.
8. Kido T, Nakata Y, Aoki K, et al. Infective endocarditis of the tricuspid valve in a non drug user. Jpn J Med 1991; 30:154–156.
9. Brouqui P, Raoult D. New insight into the diagnosis of fastidious bacterial endocarditis. FEMS Immunol Med Microbiol 2006;47:1–13.
10. Suzan Saçar, Derya Hırçın Cenger, Semra Toprak Kavas, Ali Asan, Melek Demir,Mustafa Saçar, Hüseyin Turgut. Brucella Melitensis’in Neden Olduğu Brusella Endokarditi. Dicle Tıp Derg 2008;35:58-60.
11. Crane LR, Levine DP, Zervos MJ et al. Bacteremia in narcotic addicts at the Detroit Medical Center. I. Microbiology, epidemiology, risk factors and empiric therapy. Rev Infect Dis 1986;8:364–73.
12. Avrupa Kardiyoloji Derneği (ESC) İnfektif Endokardit Tanı, Önleme ve Tedavi Görev Grubu. İnfektif endokardit tanı, önleme ve tedavi kılavuzu (2009 Güncellemesi) Eur Heart J 2009;30:2369-2413.