dic ABC Imagem Cardiovascular Arq Bras Cardiol: Imagem cardiovasc. 2675-312X Sociedade Brasileira de Cardiologia 2675-312X/20213401eabc161 10.47593/2675-312X/20213401eabc161 Image Eustachian Valve Endocarditis Associated with Complicated Cardiac Resynchronization Therapy Defibrillator Generator Pocket Infection Endocardite da Válvula de Eustáquio Associada à Infecção Complicada do Gerador de Terapêutica de Ressincronização Cardíaca com Desfibrilador PiresMaria Inês Fiuza Branco 1 AlmeidaInês 1 GonçalvesMaria Luísa 1 SantosJoão Miguel 1 CorreiaMiguel 1 Tondela-Viseu Hospital Center Viseu Portugal Cardiology Service, Tondela-Viseu Hospital Center, EPE, Viseu, Portugal. Mailing Address: Maria Inês Fiuza Branco Pires • Serviço de Cardiologia, Centro Hospitalar Tondela-Viseu, EPE – Avenida Rei D. Duarte – 3504-509 – Viseu – E-mail: inesfbpires@gmail.com

Authors’ contributions

Research conception and design: MIFB Pires, I Almeida, ML Gonçalves, JM Santos, M Correia; data collection: MIFB Pires, I Almeida, ML Gonçalves, JM Santos, M Correia; manuscript writing: MIFB Pires, I Almeida, ML Gonçalves, JM Santos, M Correia.

Conflict of interest

The authors have declared that they have no conflict of interest.

 16 06 2021 2021 34 1 eabc161 23 10 2020 09 11 2020 17 11 2020 This is an open-access article distributed under the terms of the Creative Commons Attribution License Keywords Cardiac resynchronization-therapy devices Endocarditis Heart valves

A 76-year-old male with ischemic cardiopathy was admitted with fever and purulent drainage from cardiac resynchronization therapy defibrillator generator pocket, two months after its implantation. Prompt device removal was performed. Cultures identified methicillin-sensitive Staphylococcus aureus. Transthoracic echocardiography revealed a highly mobile filamentous right atrial mass with 30mm in length, apparently attached to interatrial septum (Figure 1 and Video 1). Transesophageal echocardiography (TEE) showed that the echogenic mass was attached to the Eustachian valve (EV) (Figure 2 and Video 2) and the diagnosis of EV endocarditis was made. There was no involvement of tricuspid valve. The patient completed a 4-week course of flucloxacillin, with good clinical response and without embolic complications. Repeat TEE revealed a significant decrease in vegetation size (Figure 3 and Video 3).

Transthoracic apical 4-chamber view showing a right atrial mass with 30mm, apparently attached to interatrial septum. Transthoracic apical 4-chamber view showing a right atrial mass with 30mm, apparently attached to interatrial septum. Midesophageal modified bicaval view showing a mobile filamentous mass attached to the Eustachian valve. Midesophageal modified bicaval view showing a mobile filamentous mass attached to the Eustachian valve. Modified bicaval view revealing the decrement of vegetation size during antimicrobial therapy. Modified bicaval view revealing the decrement of vegetation size during antimicrobial therapy.