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Paradoxical embolisation to the brain in right-sided infective endocarditis and patent foramen ovale in a pregnant woman
  1. Madison S Tackett1,
  2. Taimoor Ahmed1,
  3. Sami A El-Dalati2 and
  4. Taha Ahmed1
  1. 1Department of Internal Medicine, University of Kentucky Medical Center, Lexington, Kentucky, USA
  2. 2Department of Infectious Disease, University of Kentucky Medical Center, Lexington, Kentucky, USA
  1. Correspondence to Dr Taha Ahmed; tahaahmedfairview{at}


The incidence of infective endocarditis in pregnancy has increased as a result of the opioid epidemic. Right-sided infective endocarditis (RSIE), specifically tricuspid valve endocarditis, is more commonly linked to injection drug use. In pregnant patients, a prompt diagnosis and treatment of infective endocarditis are crucial to prevent fetal and maternal morbidity and mortality. Complications associated with infective endocarditis in pregnancy include death, preterm labour and embolic disease. RSIE is classically linked to septic pulmonary emboli; however, we report a unique case of a pregnant patient with known tricuspid valve infective endocarditis. Our patient unfortunately developed an ischaemic stroke from paradoxical brain embolisation in the setting of a previously undiagnosed patient foramen ovale. Furthermore, we demonstrate the importance of considering how normal cardiac physiological changes associated with pregnancy can impact the clinical course in patients with RSIE.

  • Cardiovascular medicine
  • Interventional cardiology
  • Valvar diseases
  • Infectious diseases

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  • Contributors MST: performed the literature review, drafted the manuscript and reviewed the manuscript. TA: edited the manuscript and suggested pertinent modifications. SAED: contributed to the case presentation and discussion, revised the manuscript critically for important intellectual content and gave final approval for the version published. Taha Ahmed: designed the study, performed the literature review, drafted the manuscript and reviewed the manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Case reports provide a valuable learning resource for the scientific community and can indicate areas of interest for future research. They should not be used in isolation to guide treatment choices or public health policy.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • © BMJ Publishing Group Limited 2023. No commercial re-use. See rights and permissions. Published by BMJ.