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Aortic valve perforation and mitral valve chordal rupture as a complication of previous infective endocarditis

Authors: Taner Sen,MD.

Hospital, Cardiology
Dumlupinar University Kutahya Evliya Celebi Education and Research

On behalf of the EACVI club 35 for Turkey


 

Description

  • An 82-year-old male patient without any known cardiac disorder was admitted to the emergency room with dyspnea
  • The patient had complaints of fatigue and fever six months before the admission.
  • On physical examination, his body temperature was 36.8 °C, and auscultation showed basilar rales and an apical pansystolic murmur.
  • Transthoracic echocardiography revealed
    • normal systolic function, severe mitral regurgitation,
    • moderate-to-severe tricuspid regurgitation
    • severe aortic regurgitation
    • a fibrillary structure moving into the left ventricle with mitral valve closing and into the left atrium with mitral valve opening

Clinical case information

Modified Apical four chamber view shows a fibrillary structure that moves into the left ventricle with mitral valve closing and into the left atrium with mitral valve opening (white arrow).

Color flow image shows severe mitral regurgitation.

Ruptured chorda of anterior mitral leaflet moving into the left ventricle with mitral valve closing and into the left atrium with mitral valve opening jhgfvtransthoracic five chamber apical view.

 

Apical 4 chamber tranthoracic view shows severe mitral regurgitation.

 

Apical 5 chamber tranthoracic view shows severe aortic regurgitation.

 

Ruptured chorda of anterior mitral leaflet moving into the left ventricle with mitral valve closing and into the left atrium with mitral valve opening in zoom view.

Transesophageal echocardiography revealed

  • rupture of the noncoronary cusp of the aortic valve.
  • Color Doppler imaging showed a regurgitation jet within this ruptured segment
  • Anterior mitral valve chordal rupture and severe mitral regurgitation

The white arrowshows a hypoechogenic cystic structure on the aortic valve,suggestive of an abscess cavity as a complication of previous infective endocarditis.

The color flow image of the same view demonstrates an aortic jet through the abscess cavity into the left ventricle outflow tract, indicating rupture of the aortic valve.

The white arrows show(A) the ruptured leaflet of the aortic valve

Ruptured chorda of the anterior mitral leaflet.



Cystic structure of previous abscess formation and blood flow passing through the hole on ihat cystic structıure was shown in transesophafeal 2D and color Doppler views.

Conclusion

  • Infective endocarditis was suspected, but no causative agent was isolated from three sets of blood cultures.
  • White blood cell count, serum CRP, and sedimentation rate were in normal limits. Serologic tests for brucella were negative.
  • These findings were suggestive of a complication of infective endocarditis that previously improved, affecting both the mitral and aortic valves.
  • Surgical intervention was planned after preoperative coronary angiography.