Introduction: Fungal endocarditis in infants is rare but carries high morbidity and mortality. We present a challenging case of a 1- year-old male with Candida endocarditis involving the tricuspid valve (TV), refractory to medical therapy, who underwent successful underwent tricuspid valve replacement (TVR) using a stentless aortic bio prosthesis.

Case Description: The patient, with a history of prolonged hospital stay and broad-spectrum antibiotics and antifungal, presented with persistent fever, respiratory distress, and fungal sepsis, developed refractory TV destruction despite antifungals and antibiotics. Echocardiography revealed large vegetations on the TV measuring 22mm in widest diameter with severe regurgitation. Despite 3 weeks broad spectrum antibiotics, 4 weeks of liposomal amphotericin B and 2 weeks fluconazole, the infection persisted with worsening hemodynamics. A multidisciplinary team (pediatric cardiology, cardiac surgery, and infectious disease) opted for an Emergent Vegetectomy and Tricuspid Valve Replacement using a 19-mm bioprosthetic aortic valve. The surgery was complicated by friable tissues and extensive destruction of the valve leaflet, but postoperative recovery was remarkable.

Discussion: Fungal Endocarditis has aggressive nature specially on immunocompromised infants. An early surgical intervention has an important role when medical therapy fails. Technical challenges may encounter in infants who undergo Tricuspid Valve Replacement specifically on small anatomy and anticoagulant and antiplatelet risks.

Outcome: The child was discharged on antifungals and antiplatelet, with no recurrence. On 2 weeks post discharge OPD follow-up, patient was asymptomatic, no febrile episodes, no bleeding episodes. Continued his cardiac medications and antiplatelet.