• Images in cardiology

A 33 year old man had Wilson’s disease. One month after a successful, second liver transplant he developed a fever. He was being treated with steroids and immunosuppressive drugs. A subclavian central line had been removed two weeks previously. Multiple blood cultures grew methicillin sensitive Staphylococcus aureus. Vancomycin and gentamycin treatment was started. Transoesophageal echocardiography showed a large mobile mass (22 × 13 mm diameter) attached to the atrial surface of the anterior leaflet of the tricuspid valve (left hand panel). Open heart surgery was performed. The elongated friable vegetation, attached to the tricuspid valve (right hand panel), was excised. The valve defect was repaired with a pericardial patch. Pathological examination of the vegetation showed extensive infiltration with S aureus. The patient made an uneventful recovery. Follow up echocardiography demonstrated normal valve motion and minimal tricuspid regurgitation.