Robotic Surgery for Mastitis Complicated With Tricuspid Valve Infective Endocarditis: Case Report

                         http://austinpublishinggroup.com/cardiovascular-case-reports/

TricuspidValve Infective Endocarditis (TVIE) accounted for 5% to 10% of infective endocarditis. The researches of TVIE are increasing due to intravenous drug abusers are more often seen in healthcare settings. However, TVIE caused by mastitis is extremely rare. According to the definition by the World Health Organization (WHO), mastitis refers to as an inflammatory condition of the breast, possibly accompanied by infection and usually associated with lactation. Mastitis often occurs in postpartum women. Once abscesses form in mastitis, generally surgical incision and drainage are required. In a joint study conducted by National Yang Ming University Hospital and Heping Fuyou Branch of Taipei City Hospital, it was found that 88% of mastitis in Taiwan was caused by Staphylococcus aureus. In which, more than half of them are Methicillin Resistant Staphylococcus Aureus (MRSA). According to a study, 77% of patients can be cured from ultrasound-guided drainage without surgery. It is important to conduct health education to prevent patients from mastitis-associated complications. Once mastitis is complicated with TVIE, profound bacteremia and cardiac valve damage will be frequently accompanied. Early surgical valve repair is necessary to be considered due to Methicillin resistant Staphylococcus aureus are often seen. By robotic surgery, rapid postoperative recovery is expected due to the small surgical wound.

A35-year-old woman who breastfeeded complained of fever and chills for 2 weeks. Meanwhile, right breast pain with erythematous change over 11 to 3 o’clock was noted and mastitis was impressed. While admission, vital signs showed that blood pressure was 94/63 mmHg and heart rate was 93/min. Physical examination showed no evidence of cardiac murmur, or marble markings over bilateral legs. Laboratory test revealed leukocytosis (white blood cell, WBC 17900/ μl) and elevated C-reactive protein (242.4 mg/L). Echocardiography showed myxomatous mitral valve with mild centric mitral valve regurgitation, mild Tricuspid Valve Regurgitation (TR), a 2.1* 0.9 cm fluttering echogenic mass over posterior leaflet of tricuspid valve. Transesophageal echocardiography showed two fluttering echogenic masses over posterior and anterior leaflet (1.8* 1cm, 1.6* 1cm) and mild TR (Figure 1). Blood culture yielded Methicillin resistant Staphylococcus aureus. Thus, antibiotic with Vancomycin was prescribed. However, off-and-on fever and vomiting were still noted.