Therapeutic options in the treatment of infectious endocarditis of an implantable cardiac device lead

Right-sided endocarditis, and endocarditis of the tricuspid valve in particular, is a relatively uncommon condition, encountered in approximately 5 to 10 percent of all cases of infectious endocarditis (IE). The recent increase in the prevalence of right-sided IE is attributed to intravenous drug abuse as well as the increased utilization of implantable cardiac devices such as pacemakers, implantable cardioverter-defi brillators, and cardiac resynchronization therapy devices. These cases pose signifi cant therapeutic challenges, especially when right-sided devices are involved. We present a case of 45-year-old male patient with proven IE with involvement of the tricuspid valve and implantable cardiac device lead and demonstrate the results of an antibacterial treatment and surgical interventions carried out in two steps – explanation of the lead of the implantable cardiac device, excision of the tricuspid valve, and implantation of an epicardial implantable device; subsequent tricuspid valve replacement with mechanical valve, surgical revascularization, and fi nally replacement of the thrombosed mechanical valve with a biological valve. The optimal preoperative management and the following comprehensive surgical intervention resulted in resolution of IE as it has been demonstrated by the lack of recurrence of systemic infl ammatory response syndrome and no further hospitalisations due to cardiovascular events.