Recurrent Right Sided Endocarditis and Right Heart Failure in a Child with Ventricular Septal Defect

Background: Right-sided infective endocarditis (IE) is a rare but serious complication of congenital heart defects, particularly ventricular septal defects (VSDs). Tricuspid regurgitation (TR) can develop as a secondary consequence of recurrent right-sided IE, leading to significant hemodynamic disturbances. While most cases are managed successfully with antibiotics, a subclinical, massive, and torrential TR resulting in recurrent right heart failure (RHF) remains uncommon, particularly in the paediatric population. This case report aims to highlight the clinical challenges and management strategies in such a scenario.

Case Presentation: We present the case of a 10-year-old child with a small, previously unrecognized peri membranous VSD who developed recurrent right-sided IE. Over several months, the patient exhibited signs of right heart failure, including hepatomegaly, edema, and poor weight gain. Echocardiographic evaluation revealed significant tricuspid regurgitation secondary to extensive damage to the septal tricuspid leaflet secondary to previous vegetations consistent with infective endocarditis. Despite several courses of antibiotics, the patient continued to experience episodes of right heart failure, with progressive worsening of TR and volume overload. Surgical intervention was considered due to the failure of medical management, the persistence of heart failure.

Conclusions: This case underscores the rare but serious occurrence of recurrent right heart failure due to torrential TR in a child with a VSD complicated by infective endocarditis. While early antibiotic therapy is essential, surgical intervention may be required in cases of refractory heart failure, significant valve damage, or risk of embolic complications. Tricuspid valve repair requires a thorough approach to debridement and tissue preservation, with a focus on minimizing the use of prosthetic materials. The prognosis remains guarded in such cases, emphasizing the importance of early recognition and timely intervention to prevent further morbidity and mortality.