Right-Sided Infective Endocarditis

Aim: To report a case of right ventricular myxoma prolapsing through the tricuspid valve with an attachment of vegetation in a 3-year-old male child. Introduction: Right-sided endocarditis commonly involves the tricuspid valve. Low pressure and low oxygen saturation in the right sided cardiac chambers protect the tricuspid and pulmonary valves from being subjected to excessive strained and damage occurs from injected particulate matter, contaminated venous lines and drug solutions causing endocarditis. RV (right ventricular) myxoma harboured the infection due to trauma as a result of friction movement across the tricuspid valve. Case Report: A 3-year-old male child having the spikes of fever for 2 weeks, presented with tumor “plop” and 3/6 systolic murmur in lower left sternal border and echocardiography revealed a tumor-mimicking vegetation visible as a mass lesion across the tricuspid valve, which is attached to the interventricular septum by a pedicle suggesting a RV myxoma. The vegetation was found to be attached with the tumor and it disappeared with antibiotics and aspirin therapy and the child was advised surgical removal of the tumor. Conclusion: A diagnosis of infective endocarditis can be made in tricuspid valve dysfunction with a floating mass and fever. The tricuspid vegetations are often large and in rare instances, it may reach the size in excess of 20 mm. The cardiac myxoma with attached vegetation masquerading as vegetation mass in this case on transthoracic echocardiography and the vast majority of patients in right-sided endocarditis respond to antimicrobial therapy and do not require surgery.