# Right Ventricular Outflow Tract Endocarditis: A Very Rare Case and Short View

## TL;DR

This paper reports a rare case of infective endocarditis in the right ventricular outflow tract of an intravenous drug user, highlighting the importance of surgical intervention for diagnosis and treatment.

## Contribution

The paper presents a rare clinical case of RVOT endocarditis and emphasizes the role of surgery in atypical presentations.

## Key findings

- A 30-year-old intravenous drug user presented with RVOT vegetation and tricuspid valve vegetation.
- Surgical intervention confirmed fibrinous-thrombotic vegetation and resulted in an uneventful recovery.
- RVOT involvement in endocarditis is rare but should be considered in atypical cases.

## Abstract

Infective endocarditis involving the right ventricular outflow tract (RVOT) is rare, even among intravenous drug users, and is infrequently encountered by cardiac surgery teams. We report the case of a 30-year-old man with a history of intravenous drug use who presented with a two-month history of fever reaching 39℃. He was initially treated with antibiotics. Transthoracic and transesophageal echocardiography revealed a 2 cm² vegetation on the anterior leaflet of the tricuspid valve, causing severe tricuspid regurgitation, along with a thin, highly mobile, pedunculated mass (1.8-2 cm²) in the RVOT. Surgical intervention was indicated due to the size and mobility of both lesions and the patient's clinical history. The patient underwent tricuspid valve replacement with a No. 33 Epic Supra bioprosthesis and excision of the RVOT mass. Histopathological examination confirmed fibrinous-thrombotic vegetation in both locations. The postoperative course was uneventful. Right-sided infective endocarditis is closely associated with intravenous drug use, with the tricuspid valve being the most commonly affected site. Involvement of the RVOT is rare but should be considered. Surgery remains the gold standard for definitive diagnosis and treatment in such atypical cases and can result in a favorable outcome.