title: Eustachian valve endocarditis: Is it worth searching for?
abstract: BACKGROUND
  Only a few cases of eustachian valve endocarditis have been reported. Whether the eustachian valve is an uncommon site for a vegetation to be attached or whether the disease is missed because a systematic approach to this valve is not routinely performed in the search for vegetations is not known.
  
  
  METHODS
  Every patient suspected of having endocarditis undergoes a specific approach, which includes a systematic study of the eustachian valve. In 10 patients with large valves but without signs and symptoms of endocarditis, we identified 2 specific findings: width <3 mm and a regular oscillating movement. A blinded evaluation in the 10 control subjects and 30 patients with right-sided endocarditis, including the 5 with eustachian valve endocarditis, showed an agreement of 97% (39/40).
  
  
  RESULTS
  Five of 152 patients with right-sided endocarditis were found to have eustachian valve vegetations (3.3%). Patients were young (age range 22-34 years) and all had predisposing factors (3 intravenous drug abusers, 2 central venous lines), fever, and septic pulmonary embolism. Staphylococcus aureus was cultured in all cases. Tricuspid involvement was found in 4 patients, and only 1 patient had isolated eustachian valve endocarditis. All patients did well with culture-guided antibiotics.
  
  
  CONCLUSIONS
  Our results suggest that eustachian valve endocarditis may be more frequent than is believed. Thus a systematic interrogation of the eustachian valve should be included in the echocardiographic examination of a patient suspected of having endocarditis.
authors.affiliation: Institute of Heart Sciences (ICICOR), Hospital Universitario, Valladolid, Spain. jsancal@nexo.es
authors.forename: J A
authors.initials: JA
authors.lastname: San Román
authors.forename: I
authors.initials: I
authors.lastname: Vilacosta
authors.forename: C
authors.initials: C
authors.lastname: Sarriá
authors.forename: I
authors.initials: I
authors.lastname: Garcimartín
authors.forename: M J
authors.initials: MJ
authors.lastname: Rollán
authors.forename: F
authors.initials: F
authors.lastname: Fernández-Avilés
mesh_terms: D000328:Adult; D017548:Echocardiography, Transesophageal; D004697:Endocarditis, Bacterial / Q000145:classification* / Q000175:diagnosis*; D005260:Female; D006801:Humans; D008297:Male; D015203:Reproducibility of Results; D013203:Staphylococcal Infections / Q000175:diagnosis*; D013211:Staphylococcus aureus / Q000302:isolation & purification; D014682:Vena Cava, Inferior / Q000000981:diagnostic imaging / Q000382:microbiology*