Ebsteinââ?¬â?¢s anomaly is a rare congenital heart disease that presents with apical displacement of the septal and posterior leaflets of the\ntricuspid valve. It has a wide spectrum of clinical presentations and has been shown to manifest itself any time from birth to\nadulthood. Our patient is a 43-year-old male with a history of intravenous heroin abuse who presented to the emergency department\nwith worsening shortness of breath and lower extremity edema. He denied any prior cardiac history. A transthoracic echo showed\nnormal left ventricular function, but a large 2.2 Ã?â?? 2.1 cm echodensity on the septal leaflet of the tricuspid valve consistent with\nvegetation with severe tricuspid regurgitation and probable leaflet perforation. It also demonstrated severe right heart enlargement\nwith atrialization of the right ventricle and apical displacement of the tricuspid valve consistent with Ebsteinââ?¬â?¢s anomaly. This is a rare\ncase of an adult who presented with asymptomatic Ebsteinââ?¬â?¢s anomaly. There have been few reports of tricuspid valve endocarditis\nwith Ebsteinââ?¬â?¢s anomaly in the literature. To our knowledge, this represents the fifth reported case of a new diagnosis of Ebsteinââ?¬â?¢s\nanomaly in the setting of endocarditis and the second case of Ebsteinââ?¬â?¢s anomaly and endocarditis in an intravenous drug abuser.
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