Right Sided Infective Endocarditis During Pregnancy:A Case Report And Literature Review

Objective:Based on the clinical data of a patient with right sided infective endocarditis during pregnancy and reviewing relevant literatures,we’ll discuss the clinical features,treatment strategies,outcomes of right sided infective endocarditis during pregnancy so as to raise the awareness and improve the level of treatment.Methods:By retrospectively analyzing a case of right sided infective endocarditis during pregnancy in the first Hospital of Shanxi Medical University and searching the relevant literatures,we conducted data extraction including clinical manifestation,risk factors,position of vegetations,results of blood culture,treatment strategies and maternal-infant outcomes to make an analysis.Results:1.A young pregnant woman,admitted to our hospital for intermittent fever,was diagnosed as tricuspid valve infective endocarditis according to the results of blood culture and echocardiography.After Inviting multiple departments for consultation and assessment,we gave the patient a cesarean section(a male neonate delivered)and adequate antibiotics for treatment,then her condition improved significantly and there is no cardiac surgery required.The patient with her son continued to attend for three-month follow-up and they are in a healthy condition.2.With our case,a total of 15 articles were included,involving 18 cases of right sided infective endocarditis during pregnancy.The average age was(27.7±4.8)years,the average onset gestational age was(27.8±6.9)weeks.Fever,cough,anemia and shortnessof breath/dyspnea were the common symptoms,with or without systolic heart murmur.The major risk factors were congenital heart disease and intravenous drug abuse.The vegetation usually attached to tricuspid valve,the second is pulmonary valve.The positive rate of blood culture was high,and the detected major pathogenic bacteria were Staphylococcus and Streptococcus.In terms of treatment,most pregnancies were terminated by cesarean section,antibiotic therapy is the foundation of infective endocarditis and depending on the patient’s condition,cardiac surgery may or may not be performed.Of the 18 cases,all pregnant women are alive,one neonate is dead.The follow-up was basically good.Conclusion:1.Right sided infective endocarditis during pregnancy is quite rare and complex,which requires multi-department collaborative management.2.Right sided infective endocarditis during pregnancy is common in mid to late gestation,sees more at congenital heart disease and injecting drug users.The detected major pathogenic bacteria is Staphylococcus.The vegetation usually attached to tricuspid valve and pulmonary valve.3.The clinical manifestations of right sided infective endocarditis during pregnancy are atypical and lack of specificity.When pregnant women with unexplained fever and pulmonary symptoms,especially those who have heart murmur,it is very necessary to inquire about their medical history in detail as well as improving blood culture and echocardiography.4.Right sided infective endocarditis during pregnancy needs individualized treatment,antibiotic therapy is the foundation,it is very significant for maternal-infant outcomes to select appropriate surgical procedures and the timing of termination.