A case of tricuspid valve stenosis after pacemaker implantation with infective endocarditis.

A 68-year-old male patient was admitted for extremities edema and diagnosed with infective endocarditis (IEIE). The patient underwent mitral and aortic valve mechanical valve replacement due to rheumatic heart valve disease 26 years ago. He underwent mechanical aortic valve and bioprosthetic tricuspid valve replacement due to mechanical aortic valve dysfunction and severe tricuspid valve regurgitation 1 year ago. Two months ago, the patient underwent emergency permanent pacemaker implantation due to syncope caused by a third-degree atrioventricular block. The patient was admitted to the emergency with fever and worsening dyspnea 1 h ago. Transthoracic echocardiography revealed prosthetic aortic valve severe paravalvular leak and tricuspid valve stenosis with vegetation. The patient was scheduled to undergo mechanical aortic valve and bioprosthetic tricuspid valve replacement under median thoracotomy. The intraoperative transesophageal echocardiography (TEE) view showed severe paravalvular aortic valve leakage and tricuspid valve vegetation. The coronary sinus was significantly enlarged with thrombus formation, vegetation can be seen in the bioprosthetic tricuspid valve leaflets. This is a rare case of infective endocarditis with tricuspid stenosis and coronary sinus thrombosis after the placement of implanted pacemakers.