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Abbas AAM, Brown PF, White RW. A rare presentation of mycotic cerebral aneurysm, subarachnoid haemorrhage, and mitral valve aneurysm in left-sided lnfective endocarditis: a case report and literature review. Eur Heart J Case Rep 2023; 7:ytad567. [PMID: 38089127 PMCID: PMC10711421 DOI: 10.1093/ehjcr/ytad567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Revised: 09/08/2023] [Accepted: 11/14/2023] [Indexed: 03/07/2024]
Abstract
Background Infective endocarditis (IE) can present as a syndromic-like condition with multisystem involvement; this can make early diagnosis particularly challenging. Rarely, left-sided IE can lead to mitral valve aneurysm formation. Showering of septic emboli to the cerebral circulation may result in a mycotic aneurysm that can rupture, leading to haemorrhagic stroke, as in this case. Case summary A 28-year-old male presented with a triad of subarachnoid haemorrhage (SAH) from mycotic cerebral aneurysm rupture, left-sided aortic and mitral valve IE causing severe regurgitation and aorto-mitral curtain fistula and mitral valve aneurysm formation. The SAH was the main initial presentation and was immediately treated with coiling by an interventional radiologist. However, the patient later developed heart failure due to severe aortic and mitral valve regurgitation that led to the diagnosis of IE. The patient underwent aortic and mitral valve replacements procedure10 days after SAH presentation. He then recovered satisfactorily from the operationa and successfully discharged home after completeing his course of intravenous antibiotics. Discussion In this article, we shed some light on this unusual syndromic presentation, elaborate on the underlying mechanism, the ultimate importance of clinical examination, pitfalls in diagnosis, the important role of the heart team in IE, and finally the timing of surgery after SAH.
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Affiliation(s)
- Ahmed A M Abbas
- Department of Surgery, University of Warith Al-Anbiyaa, Iraq-Holy Karbala / Baghdad - Karbala Road (7km from Downtown), Iraq
| | - Pamela F Brown
- Cardiothoracic Surgery Department, James Cook University Hospital, Marton Rd, Middlesbrough TS4 3BW, UK
| | - Ralph W White
- Cardiothoracic Surgery Department, James Cook University Hospital, Marton Rd, Middlesbrough TS4 3BW, UK
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Sciatti E, Merlo A, Grosu A, Balestrieri G, Veritti U, Duino V, Senni M. An incidental finding of a challenging mitral mass: cardiac surgery or not? J Cardiovasc Med (Hagerstown) 2023; 24:847-849. [PMID: 37773885 DOI: 10.2459/jcm.0000000000001558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/01/2023]
Affiliation(s)
- Edoardo Sciatti
- Cardiology Unit, Cardiovascular Department, ASST Papa Giovanni XXIII, Bergamo
| | - Anna Merlo
- University of Milan-Bicocca, Milan, Italy
| | - Aurelia Grosu
- Cardiology Unit, Cardiovascular Department, ASST Papa Giovanni XXIII, Bergamo
| | - Giulio Balestrieri
- Cardiology Unit, Cardiovascular Department, ASST Papa Giovanni XXIII, Bergamo
| | - Umbertina Veritti
- Cardiology Unit, Cardiovascular Department, ASST Papa Giovanni XXIII, Bergamo
| | - Vincenzo Duino
- Cardiology Unit, Cardiovascular Department, ASST Papa Giovanni XXIII, Bergamo
| | - Michele Senni
- Cardiology Unit, Cardiovascular Department, ASST Papa Giovanni XXIII, Bergamo
- University of Milan-Bicocca, Milan, Italy
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Wang Y, Wang S, Chen D, Li M, Mi S, Xiong L, Song W, Wang W, Yin S, Wang B. Mitral valve aneurysms: echocardiographic characteristics, formation mechanisms, and patient outcomes. Front Cardiovasc Med 2023; 10:1233926. [PMID: 37692047 PMCID: PMC10491013 DOI: 10.3389/fcvm.2023.1233926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Accepted: 08/02/2023] [Indexed: 09/12/2023] Open
Abstract
Background The accurate etiology of mitral valve aneurysm (MVA) formation is not completely understood, and the most effective management approach for this condition remains controversial. Methods We retrospectively analyzed 20 MVA patients who underwent either surgical interventions or conservative follow-ups at the Zhongnan Hospital of Wuhan University between 2017 and 2021. We examined their clinical, echocardiographic, and surgical records and tracked their long-term outcomes. Results Of the 20 patients, 12 were diagnosed with MVA using transthoracic echocardiography, seven required additional transesophageal echocardiography for a more definitive diagnosis, and one child was diagnosed during surgery. In all these patients, the MVAs were detected in the anterior mitral leaflet. We found that 15 patients (75%) were associated with infective endocarditis (IE), whereas the remaining patients were associated with bicuspid aortic valve and moderate aortic regurgitation (AR) and mild aortic stenosis (5%), congenital heart disease (5%), elderly calcified valvular disease (5%), mitral valve prolapse (5%), and unknown reasons (5%). Of the 17 patients who underwent hospital surgical interventions, two died due to severe cardiac events. The remaining 15 patients had successful surgeries and were followed up for an average of 13.0 ± 1.8 months. We observed an improvement in their New York Heart Association functional class and mitral regurgitation and AR degrees (P-value < 0.001). During follow-up, only one infant had an increased left ventricular end-diastolic diameter and left ventricular end-systolic diameter, whereas the remaining 14 patients had decreased values (P < 0.001). In addition, none of the three conservatively managed patients experienced disease progression during the 7-24 months of follow-up. Conclusions We recommend using echocardiography as a highly sensitive method for MVA diagnosis. Although most cases are associated with IE or AR, certain cases still require further study to determine their causes. A prompt diagnosis of MVA in patients using echocardiography can aid in its timely management.
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Affiliation(s)
- Yi Wang
- Department of CardiovascularUltrasound, Zhongnan Hospital of Wuhan University, Wuhan University, Wuhan, China
| | - Shuang Wang
- Department of CardiovascularUltrasound, Zhongnan Hospital of Wuhan University, Wuhan University, Wuhan, China
| | - Dandan Chen
- Department of CardiovascularUltrasound, Zhongnan Hospital of Wuhan University, Wuhan University, Wuhan, China
| | - Mengmei Li
- Department of CardiovascularUltrasound, Zhongnan Hospital of Wuhan University, Wuhan University, Wuhan, China
| | - Sulin Mi
- Department of CardiovascularUltrasound, Zhongnan Hospital of Wuhan University, Wuhan University, Wuhan, China
| | - Li Xiong
- Department of CardiovascularUltrasound, Zhongnan Hospital of Wuhan University, Wuhan University, Wuhan, China
| | - Wanwan Song
- Department of CardiovascularUltrasound, Zhongnan Hospital of Wuhan University, Wuhan University, Wuhan, China
| | - Wei Wang
- Department of CardiovascularUltrasound, Zhongnan Hospital of Wuhan University, Wuhan University, Wuhan, China
| | - Shanye Yin
- Department of Pathology, Albert Einstein College of Medicine, Bronx, NY, United States
| | - Bin Wang
- Department of CardiovascularUltrasound, Zhongnan Hospital of Wuhan University, Wuhan University, Wuhan, China
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Abdi IA, Elmi Abdi A, Farah Yusuf Mohamud M. Rare Case of Mitral Valve and Tricuspid Valve Aneurysm Presented with Progressive Dyspnea. RESEARCH REPORTS IN CLINICAL CARDIOLOGY 2023. [DOI: 10.2147/rrcc.s384517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/12/2023] Open
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Yousaf A, Ahmad M, Qureshi K, Khan H, Munir A. Post-Transcatheter Aortic Valve Replacement Infective Endocarditis Leading to Mitral Anterior Leaflet Perforation: A Case Report. Cureus 2023; 15:e35049. [PMID: 36938290 PMCID: PMC10022910 DOI: 10.7759/cureus.35049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/15/2023] [Indexed: 02/18/2023] Open
Abstract
Transcatheter aortic valve replacement(TAVR)-related infective endocarditis is a rare but fatal complication that can lead to mitral valve perforation. The clinical presentation usually includes rapidly progressive heart failure and mitral regurgitation. Transesophageal echocardiogram (TEE) is considered superior to transthoracic echocardiogram (TTE) in delineating the diagnosis of mitral valve perforation. We present a case of a 75-year-old female who had a TAVR for severe aortic stenosis three years ago and presented with new-onset atrial fibrillation and developed rapidly progressive acute decompensated heart failure. A TTE showed echogenic vegetation of the mitral valve with a perforated mitral anterior leaflet and mitral regurgitation. The blood cultures grew Group B Streptococcus, and our patient lacked the risk factors for infective endocarditis, including alcoholism, chronic liver disease, pregnancy, immunosuppression, or malignancy. This article highlights infective endocarditis with an uncommon pathogen in a patient with a prior TAVR that leads to the fatal complication of mitral valve perforation.
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Oliveira I, Cruz I, Neto A, Bragança B, Abreu G, Azevedo J, Andrade A. Mitral Valve Perforated Aneurysm: An Issue of Inflammation or Pressure Gradients? Arq Bras Cardiol 2022; 119:S0066-782X2022005017203. [PMID: 36228278 PMCID: PMC9750205 DOI: 10.36660/abc.20211031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Revised: 03/09/2022] [Accepted: 05/11/2022] [Indexed: 11/18/2022] Open
Affiliation(s)
- Inês Oliveira
- Departamento de CardiologiaCentro Hospitalar Tâmega e SousaPenafielPortugal Departamento de Cardiologia , Centro Hospitalar Tâmega e Sousa, Penafiel – Portugal
| | - Isabel Cruz
- Departamento de CardiologiaCentro Hospitalar Tâmega e SousaPenafielPortugal Departamento de Cardiologia , Centro Hospitalar Tâmega e Sousa, Penafiel – Portugal
| | - Ana Neto
- Departamento de CardiologiaCentro Hospitalar Tâmega e SousaPenafielPortugal Departamento de Cardiologia , Centro Hospitalar Tâmega e Sousa, Penafiel – Portugal
| | - Bruno Bragança
- Departamento de CardiologiaCentro Hospitalar Tâmega e SousaPenafielPortugal Departamento de Cardiologia , Centro Hospitalar Tâmega e Sousa, Penafiel – Portugal
| | - Glória Abreu
- Departamento de CardiologiaCentro Hospitalar Tâmega e SousaPenafielPortugal Departamento de Cardiologia , Centro Hospitalar Tâmega e Sousa, Penafiel – Portugal
| | - João Azevedo
- Departamento de CardiologiaCentro Hospitalar Tâmega e SousaPenafielPortugal Departamento de Cardiologia , Centro Hospitalar Tâmega e Sousa, Penafiel – Portugal
| | - Aurora Andrade
- Departamento de CardiologiaCentro Hospitalar Tâmega e SousaPenafielPortugal Departamento de Cardiologia , Centro Hospitalar Tâmega e Sousa, Penafiel – Portugal
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Maidman SD, Kiefer NJ, Bernard S, Freedberg RS, Rosenzweig BP, Bamira D, Vainrib AF, Ro R, Neuburger PJ, Basu A, Moreira AL, Latson LA, Loulmet DF, Saric M. Native mitral valve staphylococcus endocarditis with a very unusual complication: Ruptured posterior mitral valve leaflet aneurysm. Echocardiography 2021; 39:112-117. [DOI: 10.1111/echo.15254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Revised: 10/29/2021] [Accepted: 11/04/2021] [Indexed: 11/29/2022] Open
Affiliation(s)
- Samuel D. Maidman
- Leon H. Charney Division of Cardiology, NYU Grossman School of Medicine NYU Langone Health New York New York USA
| | - Nicholas J. Kiefer
- Leon H. Charney Division of Cardiology, NYU Grossman School of Medicine NYU Langone Health New York New York USA
| | - Samuel Bernard
- Leon H. Charney Division of Cardiology, NYU Grossman School of Medicine NYU Langone Health New York New York USA
| | - Robin S. Freedberg
- Leon H. Charney Division of Cardiology, NYU Grossman School of Medicine NYU Langone Health New York New York USA
| | - Barry P. Rosenzweig
- Leon H. Charney Division of Cardiology, NYU Grossman School of Medicine NYU Langone Health New York New York USA
| | - Daniel Bamira
- Leon H. Charney Division of Cardiology, NYU Grossman School of Medicine NYU Langone Health New York New York USA
| | - Alan F. Vainrib
- Leon H. Charney Division of Cardiology, NYU Grossman School of Medicine NYU Langone Health New York New York USA
| | - Richard Ro
- Leon H. Charney Division of Cardiology, NYU Grossman School of Medicine NYU Langone Health New York New York USA
| | - Peter J. Neuburger
- Department of Anesthesiology, Perioperative Care & Pain Medicine, NYU Grossman School of Medicine NYU Langone Health New York New York USA
| | - Atreyee Basu
- Department of Pathology, NYU Grossman School of Medicine NYU Langone Health New York New York USA
| | - Andre L. Moreira
- Department of Pathology, NYU Grossman School of Medicine NYU Langone Health New York New York USA
| | - Larry A. Latson
- Department of Radiology, NYU Grossman School of Medicine NYU Langone Health New York New York USA
| | - Didier F. Loulmet
- Department of Cardiothoracic Surgery, NYU Grossman School of Medicine NYU Langone Health New York New York USA
| | - Muhamed Saric
- Leon H. Charney Division of Cardiology, NYU Grossman School of Medicine NYU Langone Health New York New York USA
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Yamamoto H, Yamada H, Maeda T, Goto M, Ikeda Y, Takahashi T. Miniature Erupting Volcano-Shaped Mitral Valve Aneurysm Secondary to Streptococcus agalactiae ST1656 Endocarditis: A Case Report. Front Cardiovasc Med 2021; 8:728792. [PMID: 34490383 PMCID: PMC8416758 DOI: 10.3389/fcvm.2021.728792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Accepted: 07/29/2021] [Indexed: 11/13/2022] Open
Abstract
Mitral valve aneurysm (MVA) is a rare but life-threatening valvular pathologic entity most commonly associated with infective endocarditis (IE) of the aortic valve (AV). We describe a diabetic patient with ruptured anterior MVA secondary to capsular genotype V Streptococcus agalactiae (GBS) harboring novel ST1656 IE without AV involvement. Our patient presented with manifestations of various serious systemic and intracardiac complications, requiring early surgery, but ultimately died from non-cardiogenic causes. This case emphasizes the importance of treating MVA as a dangerous sequela of IE, of performing transesophageal echocardiography to make its accurate diagnosis and institute early surgical intervention, and of considering GBS as a rare but important causative agent of IE in elderly patients with comorbidities.
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Affiliation(s)
- Hiroyuki Yamamoto
- Department of Cardiovascular Medicine, Narita-Tomisato Tokushukai Hospital, Chiba, Japan
| | - Hiroyuki Yamada
- Department of Cardiovascular Surgery, Narita-Tomisato Tokushukai Hospital, Chiba, Japan
| | - Takahiro Maeda
- Laboratory of Infectious Diseases, Graduate School of Infection Control Sciences and Omura Satoshi Memorial Institute, Kitasato University, Tokyo, Japan
| | - Mieko Goto
- Laboratory of Infectious Diseases, Graduate School of Infection Control Sciences and Omura Satoshi Memorial Institute, Kitasato University, Tokyo, Japan
| | - Yoshihiko Ikeda
- Department of Pathology, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Takashi Takahashi
- Laboratory of Infectious Diseases, Graduate School of Infection Control Sciences and Omura Satoshi Memorial Institute, Kitasato University, Tokyo, Japan
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Sinha M, Pandey NN, Sharma A, Parashar N, Kumar S, Sharma G. Aneurysmal and obstructive lesions of the left ventricular outflow: evaluation on multidetector computed tomography angiography. Pol J Radiol 2021; 86:e195-e203. [PMID: 34093915 PMCID: PMC8147719 DOI: 10.5114/pjr.2021.105588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2020] [Accepted: 08/06/2020] [Indexed: 11/30/2022] Open
Abstract
The left ventricular outflow is an anatomically complex region situated between the anterior leaflet of the mitral valve and the left ventricular aspect of the muscular and membranous interventricular septum. It gives rise to the aorta, provides support to the aortic valvular cusps, and houses important components of the conduction system. The left ventricular outflow handles high pressures and pressure variations and is subsequently affected by a variety of aetio-pathological conditions. Diseases involving the left ventricular outflow can be intraluminal, mural, or extramural, and the consequent complications of the lesions can be local, loco-regional, or even systemic. Appropriate evaluation requires comprehensive multimodality imaging with each modality contributing to assessment of different aspects of diagnosis, lesion characterization, local extension, prognostication for systemic complications and mortality, and the decision for the approach and type of intervention and aggressive follow-up in case non-interventional management is decided. In this review, we briefly describe the relevant anatomy and the gamut of structural abnormalities pertaining to the left ventricular outflow on multidetector computed tomography angiography.
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Affiliation(s)
| | | | - Arun Sharma
- Correspondence address: Dr. Arun Sharma, 148, The Foothills, New Chandigarh (Pb), India, e-mail:
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10
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Perforated posterior mitral leaflet aneurysm in an 8-month-old infant. Cardiol Young 2021; 31:153-154. [PMID: 33070800 DOI: 10.1017/s1047951120003340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Mitral valve aneurysm not associated with infective endocarditis is rarely reported in children. We report a case of perforated posterior mitral leaflet aneurysm in an infant with reference to surgical and histopathological findings. Although its aetiology remains unclear, we suggest to include mitral valve aneurysm in differential diagnosis as a cause of mitral regurgitation in children.
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11
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Kolluru A, Behera S, Damarla V, Rajasurya V. Perforation of Anterior Mitral Valve Leaflet Aneurysm: Complication of Enterococcus Faecalis Infective Endocarditis. Cureus 2020; 12:e10249. [PMID: 33042688 PMCID: PMC7536104 DOI: 10.7759/cureus.10249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Infective endocarditis (IE) is a potentially fatal disease if untreated and transesophageal echocardiogram should be performed in all suspected cases. We report a complicated case of infective (Enterococcal faecalis) endocarditis in an elderly man who recently had a genitourinary procedure. He presented with decompensated congestive heart failure due to valvular insufficiency and was found to have multiple vegetations on aortic and mitral valves with aneurysm and perforation of the anterior mitral valve leaflet. He was appropriately treated with antibiotics and surgery. Echocardiography plays central role in risk stratification, evaluation, diagnosis and management.
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Affiliation(s)
| | - Subrat Behera
- Family Medicine, Mercyone Siouxland Medical Center, Sioux City, USA
| | - Vijay Damarla
- Hematology and Oncology, Decatur Memorial Hospital, Decatur, USA
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12
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Rajagopal R, Jagia P. Anterior Mitral Leaflet Aneurysm. Radiology 2020; 296:23. [DOI: 10.1148/radiol.2020200004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Rengarajan Rajagopal
- From the Department of Cardiovascular Radiology, Cardiothoracic Neurosciences Center, All India Institute of Medical Sciences, Ansari Nagar, Room No. 0A, New Delhi, India 110029
| | - Priya Jagia
- From the Department of Cardiovascular Radiology, Cardiothoracic Neurosciences Center, All India Institute of Medical Sciences, Ansari Nagar, Room No. 0A, New Delhi, India 110029
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Tariq M, Zahid I, Sami S. Rare aneurysm of anterior mitral valve leaflet-a case report. J Cardiothorac Surg 2019; 14:204. [PMID: 31775814 PMCID: PMC6882042 DOI: 10.1186/s13019-019-1032-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2019] [Accepted: 11/18/2019] [Indexed: 11/25/2022] Open
Abstract
Background Mitral valve aneurysm (MVA) is a saccular outpouching of the mitral leaflet which expands on systole and collapses during diastole. The case of MVA was first described in 1729 by Morand. It is one of the rare entities with a reported incidence of only 0.2–0.29% and no such case reported in Pakistan before. Case presentation A 51 year old female presented with dyspnea and chest pain for 3 months. Upon investigating, trans-esophageal echocardiography (TEE) revealed thickened anterior mitral valve leaflet with rolled up margins, forming an aneurysm, with severe mitral regurgitation. Subsequently, the valve was evaluated intra-operatively for repair but eventually had to be excised and then successfully replaced with a bioprosthetic valve. Conclusions TEE is an excellent technique to confirm the diagnosis of a mitral valve leaflet aneurysm, and depending upon the severity of the defect, valve repair can be attempted but replacement becomes the most suitable treatment modality, once repair is deemed impossible. We hereby report a rare case, where timely diagnosis, appropriate surgical intervention and regular post-operative follow up helped in achieving good prognosis of this rare entity.
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Affiliation(s)
- Muhammad Tariq
- Fellow Advance Complex Cardiac Surgery, St. Boniface Hospital, Winnipeg, Manitoba, Canada
| | - Ibrahim Zahid
- Dow Medical College, Dow University of Health Sciences, Karachi, Pakistan.
| | - Shahid Sami
- Consultant Cardiothoracic Surgeon, Aga Khan University Hospital, Karachi, Pakistan
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Vasquez-Rodriguez JF, Martínez-Caballero A, Perez-Fernandez OM, Gelves J, Medina HM, Salazar G, Manrique FT. Unusual Lesions of the Mitral Valve: Two Different Conditions with the Same Imaging Findings. CASE 2019; 3:204-209. [PMID: 31709371 PMCID: PMC6833123 DOI: 10.1016/j.case.2019.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Mitral valve (MV) aneurysms are unusual lesions, its incidence is 0.02% to 0.29%. Most cases of MV aneurysms are a complication of aortic valve endocarditis. Direct Infection of MV leaflets and degenerative lesions could cause a MV aneurysms. MV aneurysms are rarely surgical complication, however, it should be kept in mind.
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15
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Hara L, El Hattab FZ, Radi FZ, Zarzur J, Cherti M. [Perforated posterior mitral valve aneurysm: a rare complication of infective endocarditis: a case report]. Pan Afr Med J 2019; 32:178. [PMID: 31312292 PMCID: PMC6620063 DOI: 10.11604/pamj.2019.32.178.17710] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2018] [Accepted: 01/15/2019] [Indexed: 11/11/2022] Open
Abstract
Mitral valve aneurysm is a rare abnormality whose pathophysiology is poorly understood. It is defined as a bulge of the mitral valve leaflet toward the left atrium. Aneurysm in the posterior leaflet is exceptional. We report the case of a 26-year old man, who had been followed up for rheumatic aortic regurgitation for 4-years, hospitalized for febrile syndrome associated with episodes of left heart failure. Transthoracic echocardiographic examination (TTE) and transesophageal echocardiography (TEE) showed aortic valve vegetations with wide aneurysm of the small mitral valve associated with severe mitral valve regurgitation. The patient underwent mitral and aortic valve replacement with simple postoperative outcome. Clinical suspicion associated with suitable preoperative imaging and early surgical treatment are essential to recognize and treat this rare complication of infectious endocard.
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Affiliation(s)
- Loubna Hara
- Service de Cardiologie B, CHU Ibn Sina, Rabat, Maroc
| | | | | | - Jamila Zarzur
- Service de Cardiologie B, CHU Ibn Sina, Rabat, Maroc
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16
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Moretti M, Buscaglia A, Senes J, Tini G, Brunelli C, Bezante GP. Anterior Mitral Valve Aneurysm Is an Uncommon Complication of Aortic Valve Infective Endocarditis: A Case Report. AMERICAN JOURNAL OF CASE REPORTS 2018; 19:1146-1151. [PMID: 30262801 PMCID: PMC6180919 DOI: 10.12659/ajcr.909922] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Patient: Male, 62 Final Diagnosis: Mitral valve aneurysm complicating aortic valve endocarditis Symptoms: Fever Medication: — Clinical Procedure: Combined aortic valve and mitral valve replacement Specialty: Cardiology
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Affiliation(s)
- Martina Moretti
- Clinic of Cardiovascular Disease, San Martino Policlinic Hospital, University of Genova, Genova, Italy
| | - Angelo Buscaglia
- Clinic of Cardiovascular Disease, San Martino Policlinic Hospital, University of Genova, Genova, Italy
| | - Jacopo Senes
- Clinic of Cardiovascular Disease, San Martino Policlinic Hospital, University of Genova, Genova, Italy
| | - Giacomo Tini
- Clinic of Cardiovascular Disease, San Martino Policlinic Hospital, University of Genova, Genova, Italy
| | - Claudio Brunelli
- Clinic of Cardiovascular Disease, San Martino Policlinic Hospital, University of Genova, Genova, Italy
| | - Gian Paolo Bezante
- Clinic of Cardiovascular Disease, San Martino Policlinic Hospital, University of Genova, Genova, Italy
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Pena JLB, Bomfim TO, Fortes PRL, Simão-Filho C, de Souza Andrade-Filho J. Mitral valve aneurysms: Clinical characteristics, echocardiographic abnormalities, and possible mechanisms of formation. Echocardiography 2017; 34:986-991. [PMID: 28512734 DOI: 10.1111/echo.13556] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
AIMS Mitral valve aneurysms (MVA) are most frequently associated with endocarditis. Echocardiography is the method of choice for diagnosis, and color flow imaging is an important, easy method to detect MVA ruptures. We aimed to study the clinical and echocardiographic findings and their relation to the mechanism of aneurysm formation. METHODS AND RESULTS We reviewed clinical and echocardiographic records of 18 patients during a 17-year period, corresponding to 0.02% of the total studies performed at our institution. All patients underwent transthoracic echocardiogram (TTE), and all except two underwent transesophageal echocardiogram (TEE). The aneurysm was located either on the anterior leaflet (16 cases) or on the posterior leaflet (two cases). In seven cases, the probable aneurysm formation mechanism was an aortic regurgitant jet striking the anterior mitral leaflet. Perforation was present in 17 (94.4%) patients, and 10 (55.5%) cases presented more than one aneurysm. No patients underwent surgery exclusively because of the echocardiography finding. CONCLUSION Different etiologies and formation mechanisms can occur in MVA. Echocardiography plays a fundamental role, providing meticulous examination of the mitral valve anatomy and flow. Unlike standard recommendations, clinical management is possible, and diagnosis does not imply immediate surgical correction.
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Muscente F, Scarano M, Clemente D, Pezzuoli F, Parato VM. A Ruptured Mitral Valve Aneurysm as Complication of a Bicuspid Aortic Valve Endocarditis. J Cardiovasc Echogr 2017; 27:23-25. [PMID: 28465987 PMCID: PMC5353471 DOI: 10.4103/2211-4122.199063] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
We present a case of a ruptured mitral valve (MV) aneurysm as a complication of a bicuspid aortic valve (BAV) endocarditis. It is about a young 35-year-old man, admitted to Cardiology Unit because of unexpected heart failure picture. We found a BAV endocarditis complicated by anterior MV-anterior leaflet aneurysm formation and subsequent severe MV regurgitation caused by aneurysm perforation. It was a particular and rare situation characterized by an infection of anterior mitral leaflet secondary to an infected regurgitant jet of a primary aortic infective endocarditis due to a BAV. A resulting aneurysm formation on the atrial side of the mitral anterior leaflet leads later to mitral perforation. In this article, we review the more relevant medical literature on this topic.
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Affiliation(s)
- Francesca Muscente
- Depatment of Emergency, Cardiology Unit, Madonna del Soccorso Hospital, San Benedetto del Tronto, Marche Region, Italy
| | - Michele Scarano
- Depatment of Emergency, Cardiology Unit, Madonna del Soccorso Hospital, San Benedetto del Tronto, Marche Region, Italy
| | - Daniela Clemente
- Depatment of Emergency, Cardiology Unit, Madonna del Soccorso Hospital, San Benedetto del Tronto, Marche Region, Italy
| | - Franco Pezzuoli
- Depatment of Emergency, Cardiology Unit, Madonna del Soccorso Hospital, San Benedetto del Tronto, Marche Region, Italy
| | - Vito Maurizio Parato
- Depatment of Emergency, Cardiology Unit, Madonna del Soccorso Hospital, San Benedetto del Tronto, Marche Region, Italy
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Konishi T, Funayama N, Yamamoto T, Hotta D, Kikuchi K, Ohori K, Nishihara H, Tanaka S. Severe mitral regurgitation due to mitral leaflet aneurysm diagnosed by three-dimensional transesophageal echocardiography: a case report. BMC Cardiovasc Disord 2016; 16:234. [PMID: 27876001 PMCID: PMC5120478 DOI: 10.1186/s12872-016-0413-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2016] [Accepted: 11/15/2016] [Indexed: 11/28/2022] Open
Abstract
Background A small mitral valve aneurysm (MVA) presenting as severe mitral regurgitation (MR) is uncommon. Case presentation A 47-year-old man with a history of hypertension complained of exertional chest discomfort. A transthoracic echocardiogram (TTE) revealed the presence of MR and prolapse of the posterior leaflet. A 6-mm in diameter MVA, not clearly visualized by TTE, was detected on the posterior leaflet on a three-dimensional (3D) transesophageal echocardiography (TEE). The patient underwent uncomplicated triangular resection of P2 and mitral valve annuloplasty, and was discharged from postoperative rehabilitation, 2 weeks after the operation. Histopathology of the excised leaflet showed myxomatous changes without infective vegetation or signs of rheumatic heart disease. Conclusions A small, isolated MVA is a cause of severe MR, which might be overlooked and, therefore, managed belatedly. 3D TEE was helpful in imaging its morphologic details. Electronic supplementary material The online version of this article (doi:10.1186/s12872-016-0413-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Takao Konishi
- Department of Cardiology, Hokkaido Cardiovascular Hospital, 1-30, West 13, South 27, Chuou-ku, Sapporo, 064-8622, Japan. .,Department of Cancer Pathology, Hokkaido University, Graduate School of Medicine, Sapporo, Japan.
| | - Naohiro Funayama
- Department of Cardiology, Hokkaido Cardiovascular Hospital, 1-30, West 13, South 27, Chuou-ku, Sapporo, 064-8622, Japan
| | - Tadashi Yamamoto
- Department of Cardiology, Hokkaido Cardiovascular Hospital, 1-30, West 13, South 27, Chuou-ku, Sapporo, 064-8622, Japan
| | - Daisuke Hotta
- Department of Cardiology, Hokkaido Cardiovascular Hospital, 1-30, West 13, South 27, Chuou-ku, Sapporo, 064-8622, Japan
| | - Kenjiro Kikuchi
- Department of Cardiology, Hokkaido Cardiovascular Hospital, 1-30, West 13, South 27, Chuou-ku, Sapporo, 064-8622, Japan
| | - Katsumi Ohori
- Department of Cardiovascular Surgery, Hokkaido Cardiovascular Hospital, Sapporo, Japan
| | - Hiroshi Nishihara
- Department of Cancer Pathology, Hokkaido University, Graduate School of Medicine, Sapporo, Japan
| | - Shinya Tanaka
- Department of Cancer Pathology, Hokkaido University, Graduate School of Medicine, Sapporo, Japan
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Mitral valve aneurysm: A serious complication of aortic valve endocarditis. Rev Port Cardiol 2016; 35:621.e1-621.e5. [DOI: 10.1016/j.repc.2016.02.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2015] [Accepted: 02/06/2016] [Indexed: 11/18/2022] Open
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21
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Sousa MJ, Alves V, Cabral S, Antunes N, Pereira LS, Oliveira F, Silveira J, Torres S. Mitral valve aneurysm: A serious complication of aortic valve endocarditis. REVISTA PORTUGUESA DE CARDIOLOGIA (ENGLISH EDITION) 2016. [DOI: 10.1016/j.repce.2016.10.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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22
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Janardhanan R, Kamal MU, Riaz IB, Smith MC. Anterior mitral valve aneurysm: a rare sequelae of aortic valve endocarditis. Echo Res Pract 2016; 3:K7-K13. [PMID: 27249815 PMCID: PMC5323869 DOI: 10.1530/erp-16-0003] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2016] [Accepted: 03/10/2016] [Indexed: 12/03/2022] Open
Abstract
In intravenous drug abusers, infective endocarditis usually involves right-sided valves, with Staphylococcus aureus being the most common etiologic agent. We present a patient who is an intravenous drug abuser with left-sided (aortic valve) endocarditis caused by Enterococcus faecalis who subsequently developed an anterior mitral valve aneurysm, which is an exceedingly rare complication. A systematic literature search was conducted which identified only five reported cases in the literature of mitral valve aneurysmal rupture in the setting of E. faecalis endocarditis. Real-time 3D-transesophageal echocardiography was critical in making an accurate diagnosis leading to timely intervention. Learning objectives Early recognition of a mitral valve aneurysm (MVA) is important because it may rupture and produce catastrophic mitral regurgitation (MR) in an already seriously ill patient requiring emergency surgery, or it may be overlooked at the time of aortic valve replacement (AVR). Real-time 3D-transesophageal echocardiography (RT-3DTEE) is much more advanced and accurate than transthoracic echocardiography for the diagnosis and management of MVA.
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Affiliation(s)
- Rajesh Janardhanan
- Department of Cardiology, Sarver Heart Center, Banner University Medical Center, Tucson, Arizona, USA
| | - Muhammad Umar Kamal
- Department of Cardiology, Sarver Heart Center, Banner University Medical Center, Tucson, Arizona, USA
| | - Irbaz Bin Riaz
- Department of Cardiology, Sarver Heart Center, Banner University Medical Center, Tucson, Arizona, USA
| | - M Cristy Smith
- Department of Cardiology, Sarver Heart Center, Banner University Medical Center, Tucson, Arizona, USA
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Seratnahaei A, Bailey AL, Hensley PJ, O'Connor W, Smith MD. Infective Endocarditis Complicated by Mitral Valve Aneurysm: Pathologic and Echocardiographic Correlations. Echocardiography 2015; 32:1417-22. [PMID: 25930970 DOI: 10.1111/echo.12958] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Infective endocarditis is a well-described cardiovascular disease that causes significant morbidity and mortality despite medical and surgical advances. Complications of endocarditis include heart failure, systemic embolization, and valvular destruction including valve aneurysms which increase morbidity and mortality. Mitral valve aneurysms are rarely encountered in the clinical setting. We present eight mitral valve aneurysm cases and discuss a new potential pathogenesis of this deadly endocarditis complication. Pathologic evaluation suggests that neovascularization of the anterior mitral valve leaflet predisposes this territory to abscess and aneurysm formation. In conclusion, mitral valve aneurysms appear to be another form of intravalvular abscess which has expanded and should be approached aggressively with surgical intervention if indicated.
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Affiliation(s)
- Arash Seratnahaei
- Division of Cardiovascular Medicine, Gill Heart Institute, University of Kentucky Medical Center, Lexington, Kentucky
| | - Alison L Bailey
- Division of Cardiovascular Medicine, Gill Heart Institute, University of Kentucky Medical Center, Lexington, Kentucky
| | - Patrick J Hensley
- Department of Pathology, University of Kentucky Medical Center, Lexington, Kentucky
| | - William O'Connor
- Department of Pathology, University of Kentucky Medical Center, Lexington, Kentucky
| | - Mikel D Smith
- Division of Cardiovascular Medicine, Gill Heart Institute, University of Kentucky Medical Center, Lexington, Kentucky
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24
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Uematsu S, Ashihara K, Tomioka H, Takagi A. Large mitral valve aneurysm with infective endocarditis. BMJ Case Rep 2015; 2015:bcr-2014-209092. [PMID: 25878230 DOI: 10.1136/bcr-2014-209092] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
A 63-year-old man with infective endocarditis (IE) was admitted to our hospital after experiencing acute heart failure. A two-dimensional transthoracic and transesophageal echocardiography revealed vegetation attached to both aortic and mitral valves, a very large mitral valve aneurysm, a severe mitral regurgitation jet issuing from a mitral valve perforation and severe aortic regurgitation. Three days after admission, both the aortic and mitral valves were replaced. The patient received antibiotic therapy for 6 weeks postoperatively and recovered with no neurological complications. Although the patient was discharged without recurrence of IE, his transthoracic and transesophageal echocardiography showed periprosthetic mitral regurgitation, requiring him to receive close follow-up monitoring. This case report exemplifies the rather unusual, but important, complications of aortic valve IE, and suggests some suitable forms of intervention.
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Affiliation(s)
- Shoko Uematsu
- Department of Cardiology, Tokyo Metropolitan Tama Medical Center, Tokyo, Japan
| | - Kyomi Ashihara
- Department of Cardiology, Tokyo Women's Medical University, Tokyo, Japan
| | - Hideyuki Tomioka
- Department of Cardiovascular Surgery, Tokyo Women's Medical University, Tokyo, Japan
| | - Atsushi Takagi
- Department of Cardiology, Saiseikai Kawaguchi General Hospital, Kawaguchi, Japan
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25
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Eiseman MS, Schroeder AR, Rutkowski PS, Rashid ZA, Pagel PS. An unusual cause of severe mitral regurgitation in a patient with aortic valve endocarditis. J Cardiothorac Vasc Anesth 2014; 28:1432-4. [PMID: 24461358 DOI: 10.1053/j.jvca.2013.10.021] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2013] [Indexed: 11/11/2022]
Affiliation(s)
| | | | | | - Zahir A Rashid
- Cardiothoracic Surgery, Medical College of Wisconsin, Milwaukee, WI
| | - Paul S Pagel
- Anesthesia Service, Clement J. Zablocki Veterans Affairs Medical Center, Milwaukee, WI.
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26
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Vijay SK, Tiwari BC, Misra M, Dwivedi SK. Incremental Value of Three-Dimensional Transthoracic Echocardiography in the Assessment of Ruptured Aneurysm of Anterior Mitral Leaflet. Echocardiography 2013; 31:E24-6. [DOI: 10.1111/echo.12356] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Affiliation(s)
- Sudarshan Kumar Vijay
- Department of Cardiology; Dr. Ram Manohar Lohia Institute of Medical Sciences; Lucknow India
| | - Bhuwan Chandra Tiwari
- Department of Cardiology; Dr. Ram Manohar Lohia Institute of Medical Sciences; Lucknow India
| | - Mukul Misra
- Department of Cardiology; Dr. Ram Manohar Lohia Institute of Medical Sciences; Lucknow India
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27
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Infective Endocarditis Presenting as an Isolated Aneurysm of the Posterior Mitral Leaflet. Can J Cardiol 2013; 29:751.e11-3. [DOI: 10.1016/j.cjca.2012.09.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2012] [Revised: 09/20/2012] [Accepted: 09/20/2012] [Indexed: 11/22/2022] Open
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28
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Pachirat O, Taksinachanekit S, Mootsikapun P, Kerdsin A. Human Streptococcus suis Endocarditis: Echocardiographic Features and Clinical Outcome. CLINICAL MEDICINE INSIGHTS-CARDIOLOGY 2012; 6:119-23. [PMID: 22872789 PMCID: PMC3411327 DOI: 10.4137/cmc.s9793] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
BACKGROUND Human Streptococcus suis endocarditis occurs infrequently and continues to be a serious illness with high mortality. However, knowledge of the echocardiographic features and clinical outcome of this disease remains unclear. METHODS One hundred and fourteen patients were identified in a prospective study, and hospitalized at Queen Sirikit Heart Center and Srinagarind Hospital, Khon Kaen University. Echocardiography was routinely performed in all patients. RESULTS Between January 2010 and December 2011, three cases of S. suis endocarditis were diagnosed. All cases were male and aged 27-53 years. The most common risk factor for contracting S. suis infection was eating undercooked pork. Three patients presented with congestive heart failure. Transthoracic echocardiography demonstrated large, highly mobile vegetations and severe valvular damage. Aortic valve involvement was documented in two patients, and mitral valve involvement in one. One patient presented with embolic stroke and one with arterial occlusion. All patients underwent urgent valve replacement with a good clinical outcome. CONCLUSION The echocardiographic features of S. suis endocarditis show destructive, extensive valvular damage and early embolization with a fulminant course, needing early surgical intervention with a good clinical outcome.
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29
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Kim DJ, Cho KI, Jun HJ, Kim YJ, Song YJ, Jhi JH, Chon MG, Kim SM, Lee HG, Kim TI. Perforated Mitral Valve Aneurysm in the Posterior Leaflet without Infective Endocarditis. J Cardiovasc Ultrasound 2012; 20:100-2. [PMID: 22787528 PMCID: PMC3391625 DOI: 10.4250/jcu.2012.20.2.100] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2011] [Revised: 02/26/2012] [Accepted: 05/15/2012] [Indexed: 11/22/2022] Open
Abstract
Aneurysm of the mitral valve, although uncommon, occurs most commonly in association with infective endocarditis of the aortic valve and true mitral valve aneurysm is a rare cause of mitral regurgitation. We report a case with perforated mitral valve aneurysm in the posterior leaflet without concurrent infective endocarditis initially mistaken diagnosis of cystic mass, which was confirmed at operation with successful mitral valve annuloplasty.
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Affiliation(s)
- Dong-Jun Kim
- Division of Cardiology, Department of Internal Medicine, Maryknoll Medical Center, Busan, Korea
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30
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Piazza N, Marra S, Webb J, D'Amico M, Rinaldi M, Boffini M, Comoglio C, Scacciatella P, Kappetein AP, de Jaegere P, Serruys PW. Two cases of aneurysm of the anterior mitral valve leaflet associated with transcatheter aortic valve endocarditis: a mere coincidence? J Thorac Cardiovasc Surg 2010; 140:e36-8. [PMID: 20167335 DOI: 10.1016/j.jtcvs.2009.11.012] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2009] [Accepted: 11/06/2009] [Indexed: 12/01/2022]
Affiliation(s)
- Nicolo Piazza
- Division of Cardiology, Erasmus MC, Thoraxcenter, Rotterdam, The Netherlands
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31
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Pederzolli N, Agostini F, Fiorani V, Tappainer E, Nocchi A, Manfredi J, Mantovani P, Zogno M. Postendocarditis mitral valve aneurysm. J Cardiovasc Med (Hagerstown) 2009; 10:259-60. [PMID: 19283883 DOI: 10.2459/jcm.0b013e32831fb22a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Mitral valve aneurysm is defined as a localized, thin-walled, saccular bulge of the mitral leaflet toward the left atrium. In this study, we report a case of mitral aneurysm of the posterior leaflet (scallop P3) secondary to primary mitral endocarditis in a patient who underwent prosthetic aortic valve replacement and coronary artery bypass graft.
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Affiliation(s)
- Nicola Pederzolli
- Cardiac Surgery Unit, 'C. Poma' Hospital, Via Albertoni 1, 46100 Mantova, Italy.
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32
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Perl S, Maier R, Watzinger N. A sequel of pacemaker infection. Clin Res Cardiol 2007; 96:632-3. [PMID: 17676351 DOI: 10.1007/s00392-007-0550-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2006] [Accepted: 05/07/2007] [Indexed: 10/23/2022]
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33
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Lee CH, Tsai LM. An aneurysm of posterior mitral valve mimicking a huge vegetation. Int J Cardiol 2006; 107:277-8. [PMID: 16412809 DOI: 10.1016/j.ijcard.2005.01.066] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2005] [Accepted: 01/19/2005] [Indexed: 12/01/2022]
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34
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Lee CH, Tsai LM. Transesophageal echocardiographic recognition of mitral valve aneurysm. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2005; 24:1141-4. [PMID: 16040830 DOI: 10.7863/jum.2005.24.8.1141] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Affiliation(s)
- Cheng-Han Lee
- Department of Internal Medicine, School of Medicine, National Cheng Kung University Hospital, Tainan, Taiwan
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35
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Androulakis A, Aggeli C, Chrisos D, Kallikazaros I, Toutouzas P. Perforated aneurysm on the posterior leaflet of the mitral valve. Int J Cardiol 2005; 98:163-4. [PMID: 15676185 DOI: 10.1016/j.ijcard.2003.11.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2003] [Revised: 11/12/2003] [Accepted: 11/17/2003] [Indexed: 11/25/2022]
Abstract
We present a case of a 71-year-old homeless diabetic man who was hospitalized due to bilateral cellulitis of the lower limbs. Because of severe calcific aortic stenosis, he had undergone valve replacement by a bioprosthesis 3 years earlier. Except from the two preadmission days, he reported no fever, malaise, or weight loss at any time after surgery. On examination, no specific signs or symptoms suggesting infective endocarditis were noted. After six blood cultures were taken, the patient was put on cloxacillin, clindamycin and gentamicin. All the six blood cultures were finally proven to be negative.
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36
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Okahashi N, Watanabe N, Akasaka T, Akiyama M, Wada N, Kawamoto T, Yoshida K. Perforated Mitral Valve Aneurysm in the Anterior Leaflet Associated With Lateral Scallop Prolapse. J Echocardiogr 2005. [DOI: 10.2303/jecho.3.46] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Abstract
A case of mitral valve aneurysm associated with infective endocarditis is reported. Two-dimensional echocardiography revealed a saccular structure in the anterior leaflet that bulged into the left atrium throughout the cardiac cycle. During operation, the vegetation on the commissure of the right and left aortic leaflet and a 3-mm perforation on the noncoronary leaflet were found. The mitral valve and aortic valve were replaced with mechanical prosthesis. Pathology of the excised valves showed inflammation. For this patient, we considered that the infected aortic regurgitant jet striking the ventricular surface of the anterior mitral leaflet could be the mechanism of the leaflet aneurysm.
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Affiliation(s)
- Changqing Gao
- Department of Cardiovascular Surgery, PLA General Hospital, PLA Institute of Cardiac Surgery, Beijing, China.
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38
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Halkos ME, Symbas JD, Felner JM, Symbas PN. Aneurysm of the Mitral Valve: A Rare Complication of Aortic Valve Endocarditis. Ann Thorac Surg 2004; 78:e65-6. [PMID: 15464455 DOI: 10.1016/j.athoracsur.2003.12.073] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/29/2003] [Indexed: 11/16/2022]
Abstract
A 45-year-old man presented to our hospital with severe dyspnea 4 months after antibiotic treatment for aortic valve endocarditis. Transesophageal echocardiography revealed severe aortic regurgitation and an aneurysm of the anterior leaflet of the mitral valve. In addition to aortic valve replacement, we excised the aneurysm and repaired the anterior leaflet of the mitral valve. Clinical suspicion, appropriate preoperative imaging, and timely surgical intervention are essential to recognize and treat this rare complication of bacterial endocarditis.
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Affiliation(s)
- Michael E Halkos
- Cardiothoracic Surgery, Grady Memorial Hospital, Emory University School of Medicine, Atlanta, Georgia, USA.
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39
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Vieira MLC, Pomerantzeff PM, Pillco LLS, Da Costa JM, Mathias W, Leal SB, Grinberg M, Andrade JL, Ramires JAF. Conservative surgical treatment of anterior mitral valve aneurysm secondary to aortic valve endocarditis. Echocardiography 2003; 20:435-8. [PMID: 12848863 DOI: 10.1046/j.1540-8175.2003.03074.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Marcelo L C Vieira
- Division of Imaging Diagnosis, Sector of Echocardiography, University of São Paulo Medical School, São Paulo, Brazil.
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40
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Janelle GM, Mnookin SC, Thomas JJ, Paulus DA, Martin TD. Valvular pathology diagnosed with transesophageal echocardiography during aortic root replacement. J Cardiothorac Vasc Anesth 2003; 17:271-2. [PMID: 12698417 DOI: 10.1053/jcan.2003.60] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Gregory M Janelle
- Department of Anesthesiology, University of Florida College of Medicine, Gainesville, FL 32610-0254, USA.
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41
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Rachko M, Safi AM, Yeshou D, Salciccioli L, Stein RA. Anterior mitral valve aneurysm: a subaortic complication of aortic valve endocarditis: a case report and review of literature. HEART DISEASE (HAGERSTOWN, MD.) 2001; 3:145-7. [PMID: 11975784 DOI: 10.1097/00132580-200105000-00003] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Mitral valve aneurysm is a rare cause of mitral regurgitation, and is usually associated with aortic valve endocarditis. Prompt diagnosis and early surgical treatment can prevent complications such as embolization and rupture of the aneurysm. The authors report a case of aortic valve endocarditis and mitral valve aneurysm in a patient who initially presented with urinary tract infection.
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Affiliation(s)
- M Rachko
- Division of Cardiology, the Brooklyn Hospital Center, New York 11201, USA
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42
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Marcos-Alberca P, Rey M, Serrano JM, Fernández-Rozas I, Navarro F, Contreras A, Rábago R. Aneurysm of the anterior leaflet of the mitral valve secondary to aortic valve endocarditis. J Am Soc Echocardiogr 2000; 13:1050-2. [PMID: 11093109 DOI: 10.1067/mje.2000.105892] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Aneurysm of the anterior mitral leaflet is a rare complication of infective aortic valve endocarditis, the natural evolution of which is generally its rupture, with subsequent acute and severe mitral regurgitation. Its presence cannot be recognized with transthoracic echocardiography and even in surgery. We describe a 78-year-old man with aortic valve endocarditis, in whom transesophageal echocardiography was essential for the diagnosis of this complication, its therapeutic management, and the postoperative follow-up after simple valve repair. In addition, the most appropriate surgical approach is discussed.
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Affiliation(s)
- P Marcos-Alberca
- Laboratory of Echocardiography, Cardiology Department, Fundación Jiménez Díaz, Universidad Autónoma de Madrid, Spain
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Vilacosta I, San Román JA, Sarriá C, Iturralde E, Graupner C, Batlle E, Peral V, Aragoncillo P, Stoermann W. Clinical, anatomic, and echocardiographic characteristics of aneurysms of the mitral valve. Am J Cardiol 1999; 84:110-3, A9. [PMID: 10404866 DOI: 10.1016/s0002-9149(99)00206-4] [Citation(s) in RCA: 55] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
This study describes the clinical, anatomic, echocardiographic, and Doppler features of 13 patients with mitral valve aneurysms. Eleven patients had definitive criteria for infective endocarditis. Transesophageal echocardiography was superior to conventional echocardiography in detecting and assessing aneurysms. Patients with heart failure required surgery. Echocardiographic detection of this lesion should not be, by itself, an immediate surgical indication.
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Affiliation(s)
- I Vilacosta
- Department of Cardiology, Hospital Clínico San Carlos, Spain
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45
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Nakayama M, Isobe F, Yutani C. Aneurysmal pouch on left coronary cusp accompanied by bacterial endocarditis. THE JAPANESE JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY : OFFICIAL PUBLICATION OF THE JAPANESE ASSOCIATION FOR THORACIC SURGERY = NIHON KYOBU GEKA GAKKAI ZASSHI 1998; 46:667-70. [PMID: 9785861 DOI: 10.1007/bf03217800] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
A 58-year-old male was admitted to our hospital with a preliminary diagnosis of bacterial endocarditis. After admission, echocardiography indicated the presence of vegetation-like tissues on both the left coronary cusp and the anterior mitral leaflet, although retrograde aortography two months earlier hadn't indicated an abnormal finding on the aortic cusp. The vegetation-like tissues had gradually enlarged despite the administration of antibiotics at another hospital, and aortic and mitral regurgitation had become severe. We decided to perform replacements of the aortic and mitral valves on the day of admission. During the operation, the aortic valve was found not to have vegetation, but an aneurysmal pouch on the left coronary cusp. It was supposed that either bacterial endocarditis or catheter injury had made a part of the aortic cusp weak and intolerant of diastolic pressure gradient, and as a result, the weakened part of the cusp progressively dilated into the left ventricle forming an aneurysmal pouch. To our knowledge, there have been only two previous reports of an aneurysmal pouch on the aortic cusp documented in the literature.
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Affiliation(s)
- M Nakayama
- Department of Cardiovascular Surgery, National Cardiovascular Center, Osaka, Japan
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46
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Valocik G, Allaart CP, Kamp O. Anterior mitral valve aneurysm: evaluation by three-dimensional echocardiography. J Am Soc Echocardiogr 1998; 11:673-6. [PMID: 9657408 DOI: 10.1016/s0894-7317(98)70045-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Three-dimensional reconstruction of cardiac structures is becoming increasingly important. Complete spatial visualization of cardiac structures and their relation to each other enable better understanding of both morphologic and functional lesions.
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Affiliation(s)
- G Valocik
- Department of Cardiology, Academic Hospital Free University, Amsterdam, The Netherlands
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47
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Matsumura N, Fujimoto S, Nakano H, Mizuno R, Negoro K, Yamamoto Y, Yabuta M, Nonaka H, Dohi K. A Case of Ruptured Mitral Valve Aneurysm Complicating Long-Standing Aortic Regurgitation. Echocardiography 1998; 15:401-404. [PMID: 11175056 DOI: 10.1111/j.1540-8175.1998.tb00624.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
A 53-year-old man with aortic regurgitation was admitted to our hospital because of fever. A diagnosis of ruptured mitral valve aneurysm was made by Doppler echocardiography. Aortic regurgitant flow along the anterior mitral leaflet may have predisposed to mitral valve endocarditis, aneurysm formation, and its rupture.
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Affiliation(s)
- Norihiko Matsumura
- Department of Clinico-Laboratory Diagnostics, Nara Medical University, 840 Shijocho, Kashihara, Nara 634, Japan
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48
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De Castro S, d'Amati G, Cartoni D, Venditti M, Magni G, Gallo P, Beni S, Fiorelli M, Fedele F, Pandian NG. Valvular perforation in left-sided infective endocarditis: a prospective echocardiographic evaluation and clinical outcome. Am Heart J 1997; 134:656-64. [PMID: 9351732 DOI: 10.1016/s0002-8703(97)70048-6] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
We undertook this study to determine the use of transthoracic and transesophageal echocardiography in detecting valvular perforation and the clinical impact of the latter on the outcome of left-sided infective endocarditis. Transthoracic echocardiography was performed in 58 consecutive patients with infective endocarditis. According to the study protocol, a subgroup of 42 patients also underwent transesophageal echocardiogrophy. At referral, 20 (34%) of 58 patients had echocardiographic evidence of valvular perforation (group A). No valvular perforations were found in the remaining 38 patients (group B). During a follow-up period of 27 +/- 16 months, a major complication occurred in 18 of 20 patients in group A and in 11 of 38 patients in group B (p < 0.0001). Univariate analysis indicated previous infective endocarditis, aortic involvement, and New York Heart Association functional class had a predictive value for valvular perforation (p < 0.001). Stepwise regression analysis confirmed aortic valve perforation as the only independent predictive variable for surgery and death. Valvular perforation is a common complication of infective endocarditis and is associated with an adverse outcome. Transthoracic echocardiography can detect or suggest valvular perforation in infective endocarditis, but transesophageal echocardiography better defines this complication and predicts severe heart failure or the need for early surgical management.
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49
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Abstract
This report describes the clinical and transesophageal echocardiographic findings in 2 patients with mitral and 2 with tricuspid valve aneurysms and reviews the 19 published echo-diagnosed cases. One of our patients with a mitral valve aneurysm and 12 of those in the published reports had associated aortic valve endocarditis.
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Affiliation(s)
- M Mollod
- Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia 30303, USA
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50
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Roguin A, Rinkevich D, Milo S, Reisner SA. Diagnosis of mitral valve aneurysms by transesophageal echocardiography. Am Heart J 1996; 132:689-91. [PMID: 8800044 DOI: 10.1016/s0002-8703(96)90257-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Affiliation(s)
- A Roguin
- Department of Cardiology, Rambam Medical Center, Technion Faculty of Medicine, Haifa 31096, Isreal
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