{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,20]],"date-time":"2026-05-20T22:13:02Z","timestamp":1779315182596,"version":"3.51.4"},"reference-count":16,"publisher":"BMJ","issue":"2","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2020,2,6]]},"published-print":{"date-parts":[[2020,2]]},"abstract":"<jats:p>We present the case of a patient admitted to hospital in septic shock. He had a history of tricuspid valve infective endocarditis (IE) 6 months prior and regularly injected intravenous drugs. A bedside echo on arrival confirmed vegetations on his tricuspid valve, torrential tricuspid regurgitation and signs of significantly raised right-sided pressures. The admission chest radiograph showed consolidative changes in the lungs, suggestive of septic pulmonary emboli. He was commenced on antibiotics and treated in the high-dependency unit. He subsequently developed an acutely ischaemic right foot and nasal tip. Suspicions were raised of a paradoxical septic embolus through a right-to-left shunt, subsequently confirmed on bubble echo which showed passage of agitated saline between the atria. This was not apparent clinically or on echocardiogram during his previous episode of tricuspid valve IE, raising the possibility of the development of an acquired inter-atrial communication since his previous episode.<\/jats:p>","DOI":"10.1136\/bcr-2019-233477","type":"journal-article","created":{"date-parts":[[2020,2,21]],"date-time":"2020-02-21T04:29:57Z","timestamp":1582259397000},"page":"e233477","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":5,"title":["Systemic septic emboli in tricuspid endocarditis due to an atrial communication with a right-to-left shunt"],"prefix":"10.1136","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2573-8808","authenticated-orcid":false,"given":"Olivia","family":"Farrant","sequence":"first","affiliation":[{"name":"Mortimer Market Centre, Central and North West London NHS Foundation Trust, London, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gabriella","family":"Scozzi","sequence":"additional","affiliation":[{"name":"Chelsea and Westminster Healthcare NHS Trust, London, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rebecca","family":"Hughes","sequence":"additional","affiliation":[{"name":"Barts Heart Centre, Barts and The London NHS Trust, London, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2020,2,20]]},"reference":[{"key":"2025082713055911000_13.2.e233477.1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejim.2013.01.010"},{"key":"2025082713055911000_13.2.e233477.2","unstructured":"Chahoud J , Sharif Yakan A , Saad H , et al . And pulmonary infiltrates: an update. Cardiology in Review 2016."},{"key":"2025082713055911000_13.2.e233477.3","doi-asserted-by":"crossref","first-page":"255","DOI":"10.21037\/acs.2017.03.09","article-title":"Tricuspid valve endocarditis","volume":"6","author":"Hussain","year":"2017","journal-title":"Ann Cardiothorac Surg"},{"key":"2025082713055911000_13.2.e233477.4","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(08)61311-2"},{"key":"2025082713055911000_13.2.e233477.5","first-page":"511","article-title":"[Tricuspid endocarditis with right-left shunt in the atrium]","volume":"79","author":"Bru","year":"1986","journal-title":"Arch Mal Coeur Vaiss"},{"key":"2025082713055911000_13.2.e233477.6","doi-asserted-by":"crossref","first-page":"412","DOI":"10.1016\/S0894-7317(00)70012-5","article-title":"Persistent hypoxemia occurring as a complication of tricuspid valve endocarditis","volume":"13","author":"Turek","year":"2000","journal-title":"J Am Soc Echocardiogr"},{"key":"2025082713055911000_13.2.e233477.7","first-page":"23","article-title":"[Tricuspid endocarditis with right-left auricular shunt through a patent foramen ovale]","volume":"36","author":"Morelon","year":"1987","journal-title":"Ann Cardiol Angeiol"},{"key":"2025082713055911000_13.2.e233477.8","doi-asserted-by":"publisher","DOI":"10.1016\/S0828-282X(09)70515-X"},{"key":"2025082713055911000_13.2.e233477.9","doi-asserted-by":"crossref","unstructured":"Nii T , Yoshikawa H , Okabe T , et al . Septic pulmonary and systemic embolism in tricuspid endocarditis. BMJ Case Rep 2014;2014. doi:doi:10.1136\/bcr-2014-206569. [Epub ahead of print: 24 Nov 2014].","DOI":"10.1136\/bcr-2014-206569"},{"key":"2025082713055911000_13.2.e233477.10","doi-asserted-by":"crossref","first-page":"67","DOI":"10.1007\/s12574-012-0116-2","article-title":"Endophthalmitis as a first manifestation of right-sided endocarditis in a patient with patent foramen ovale","volume":"10","author":"Rodrigues","year":"2012","journal-title":"J Echocardiogr"},{"key":"2025082713055911000_13.2.e233477.11","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejim.2008.08.008"},{"key":"2025082713055911000_13.2.e233477.12","doi-asserted-by":"crossref","unstructured":"Patti R , Gupta SS , Kupfer Y . Right sided infective endocarditis and systemic emboli. QJM An Int J Med 2018.","DOI":"10.1093\/qjmed\/hcy187"},{"key":"2025082713055911000_13.2.e233477.13","doi-asserted-by":"crossref","first-page":"152","DOI":"10.1007\/s12574-018-0371-y","article-title":"A rare case of paradoxical embolism from tricuspid valve infective endocarditis and patent foramen ovale","volume":"16","author":"Fong","year":"2018","journal-title":"J Echocardiogr"},{"key":"2025082713055911000_13.2.e233477.14","first-page":"8","article-title":"A rare case of paradoxical left sided endocarditis through patent foramen ovale","volume":"3","author":"George","year":"2017","journal-title":"Silv Marshall J Med"},{"key":"2025082713055911000_13.2.e233477.15","unstructured":"Varghese R , Shah M . Embolic brain abscess in a patient with tricuspid valve endocarditis and a patent foramen ovale. J Neurol Res 2012;2."},{"key":"2025082713055911000_13.2.e233477.16","doi-asserted-by":"publisher","DOI":"10.3201\/eid2005.130953"}],"container-title":["BMJ Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bcr-2019-233477","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,8,27]],"date-time":"2025-08-27T20:06:10Z","timestamp":1756325170000},"score":1,"resource":{"primary":{"URL":"https:\/\/casereports.bmj.com\/lookup\/doi\/10.1136\/bcr-2019-233477"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,2]]},"references-count":16,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2020,2,20]]},"published-print":{"date-parts":[[2020,2]]}},"alternative-id":["10.1136\/bcr-2019-233477"],"URL":"https:\/\/doi.org\/10.1136\/bcr-2019-233477","relation":{},"ISSN":["1757-790X"],"issn-type":[{"value":"1757-790X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2020,2]]}}}