Hospital course
The patient was admitted to the intensive care unit
where TEE confirmed multiple bulky vegetations attached
to the tricuspid valve and protruding into the
right atrium. Significant tricuspid regurgitation and resultant
right atrial dilation were also found. Of note, a
bubble study showed a patent foramen ovale, explaining
the path of systemic emboli from the right-sided cardiac
lesion to the lower extremities. Due to the presence of
multi-organ failure and overwhelming sepsis, the patient
was deemed a poor surgical candidate. Cardiac surgery
was delayed until he could be stabilized. Unfortunately,
the patient's clinical status continued to decline, and he
developed respiratory distress and increasing altered
mental status. The patient's family requested a ‘do not
resuscitate, do not intubate’ order with no escalation of
care. Despite continued supportive medical care, the patient
died shortly thereafter, approximately 2 weeks after
his admission from the ED.