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Rupture of mitral and aortic valve leaflets as a complication of infective endocarditis

Authors : Blazej Michalski, Piotr Lipiec, J.D Kasprzak

Department of Cardiology, Medical University of Lodz.


 

Description

  • A 25 year-old male with a history of intravenous drug abuse in the preceding years and surgical treatment of aortic coarctation at the age of five was admitted to the department of cardiology due to the symptoms of congestive heart failure. The patient was recently treated with antibiotics due to infection of upper respiratory tract with high (39-40℃) fever of two-week duration.
  • On admission, the patient had blood pressure of 110/60 mmHg with tachycardia (110 beats/minute) and respiratory rate 20/minute. The physical examination revealed systolic and diastolic heart murmur and ankle edema.

Clinical case information

http://www.youtube.com/watch?v=IY6QaCFDsnQ
http://www.youtube.com/watch?v=oHRLWck9CtY
Transesophageal echocardiography (TEE) : 2D imaging of A ruptured mycotic aneurysm at the base of the anterior mitral leaflet, and bicuspid aortic valve with a cusps perforation. TEE : 3D imaging. 3D imaging of the ruptured mycotic aneurysm at the base of the anterior mitral leaflet and bicuspid aortic valve with a cusp perforation.

 

http://www.youtube.com/watch?v=yJiEFqhPNM8
http://www.youtube.com/watch?v=Vj-e7GPXPrw
TEE: 2D grayscale imaging with color Doppler. 2D grayscale imaging with color Doppler flow mapping of the ruptured mycotic aneurysm at the base of the anterior mitral leaflet with severe mitral regurgitation, and bicuspid aortic valve with a cusp perforation.. TEE: 3D imaging of the ruptured mycotic aneurysm. 3D imaging of the ruptured mycotic aneurysm at the base of the anterior mitral leaflet viewed from the left atrium .

 

http://www.youtube.com/watch?v=TNn7Xz8GbWI
http://www.youtube.com/watch?v=xeu037F-cjg
TEE: 3D imaging of the bicuspid aortic valve. 3D imaging of the bicuspid aortic valve viewed from ascendingAorta showing posterior cusp perforation. TEE: 3D - ruptured mycotic aneurysm. TEE: 3D - ruptured mycotic aneurysm at the base of the anterior mitral leaflet ( protruding into the left atrium).

 

Conclusion

TTE and TEE showed a ruptured mycotic aneurysm at the base of the anterior mitral leaflet with severe mitral regurgitation. Moreover we visualized the bicuspid aortic valve with vegetations and a cusp perforation resulting in severe aortic regurgitation 3D TEE confirmed the presence of perforated abscess on the basal portion of the anterior mitral leaflet and q perforated leaflet of the bicuspid aortic valve

Summary of findings: Aortic cusp perforation (A, D), Mitral mycotic aneurysm (B, C).

The patient was referred for urgent surgical intervention1. However, he died during the surgery due to multi-organ failure.

References

  1. Habib G, Hoen B, Tornos P et al: Guidelines on the prevention, diagnosis, and treatment of infective endocarditis (new version 2009): the Task Force on the Prevention, Diagnosis, and Treatment of Infective Endocarditis of the European Society of Cardiology (ESC). Endorsed by the European Society of Clinical Microbiology and Infectious Diseases (ESCMID) and the International Society of Chemotherapy (ISC)for Infection and Cancer. Eur Heart J. 2009:30:2369-413.