{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,27]],"date-time":"2026-05-27T23:13:28Z","timestamp":1779923608576,"version":"3.53.1"},"reference-count":12,"publisher":"BMJ","issue":"8","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2021,8,10]]},"published-print":{"date-parts":[[2021,8]]},"abstract":"<jats:p>A 34-year-old man with a medical history of injection drug use presented with 2 weeks of weakness, nausea, vomiting and septic shock secondary to infective endocarditis of a native tricuspid valve. On admission, CT chest demonstrated multiple cavitary lesions as well as numerous small infarcts seen on MRI brain concerning for systemic septic emboli. Subsequent transthoracic echo with bubble study revealed a large patent foramen ovale (PFO). The patient later received surgical debulking of his tricuspid valve vegetation with AngioVac. Subsequently, PFO closure was performed with a NobleStitch device. The case presented here demonstrates the importance of having a high index of suspicion with right-sided endocarditis and the development of other systemic signs and symptoms. It also underscores the necessity of a multidisciplinary team of cardiologists, surgeons, infectious disease specialists and intensivists in the treatment of these complicated patients.<\/jats:p>","DOI":"10.1136\/bcr-2021-243370","type":"journal-article","created":{"date-parts":[[2021,8,20]],"date-time":"2021-08-20T12:14:58Z","timestamp":1629461698000},"page":"e243370","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":10,"title":["Patient with systemic emboli in the setting of <i>Klebsiella oxytoca<\/i> tricuspid valve endocarditis and patent foramen ovale treated with NobleStitch and AngioVac"],"prefix":"10.1136","volume":"14","author":[{"given":"John","family":"Leso","sequence":"first","affiliation":[{"name":"Internal Medicine, Albany Medical College, Albany, New York, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Majd","family":"Al-Ahmad","sequence":"additional","affiliation":[{"name":"Internal Medicine, Albany Medical College, Albany, New York, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Drinnon O","family":"Hand","sequence":"additional","affiliation":[{"name":"Internal Medicine, Albany Medical College, Albany, New York, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2021,8,20]]},"reference":[{"key":"2025082802325677000_14.8.e243370.1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0082665"},{"key":"2025082802325677000_14.8.e243370.2","doi-asserted-by":"publisher","DOI":"10.1136\/heart.89.5.577"},{"key":"2025082802325677000_14.8.e243370.3","doi-asserted-by":"crossref","DOI":"10.1161\/JAHA.120.017293","article-title":"Right-Sided infective endocarditis 2020: challenges and updates in diagnosis and treatment","volume":"9","author":"Shmueli","year":"2020","journal-title":"J Am Heart Assoc"},{"key":"2025082802325677000_14.8.e243370.4","doi-asserted-by":"publisher","DOI":"10.7326\/0003-4819-147-12-200712180-00002"},{"key":"2025082802325677000_14.8.e243370.5","doi-asserted-by":"crossref","first-page":"1316.e5","DOI":"10.1016\/j.echo.2007.03.013","article-title":"A 38-year-old Hispanic woman with paradoxical embolism and Libman-Sacks endocarditis involving the tricuspid valve","volume":"20","author":"Zurick","year":"2007","journal-title":"J Am Soc Echocardiogr"},{"key":"2025082802325677000_14.8.e243370.6","first-page":"395","article-title":"Unusual association: Streptococcus bovis tricuspid endocarditis with atrial-septal aneurysm and patent foramen ovale","volume":"130","author":"Sommer","year":"2000","journal-title":"Schweiz Med Wochenschr"},{"key":"2025082802325677000_14.8.e243370.7","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":"2025082802325677000_14.8.e243370.8","doi-asserted-by":"crossref","first-page":"34","DOI":"10.15420\/icr.2018.33.2","article-title":"Patent foramen ovale closure in 2019","volume":"14","author":"Giblett","year":"2019","journal-title":"Interv Cardiol"},{"key":"2025082802325677000_14.8.e243370.9","doi-asserted-by":"crossref","unstructured":"Turc G , Calvet D , Gu\u00e9rin P , et al . Closure, anticoagulation, or antiplatelet therapy for cryptogenic stroke with patent foramen ovale: systematic review of randomized trials, sequential Meta\u2010Analysis, and new insights from the close study. 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