Aortic and Mitral Valve Replacement Due to Extensive Inflammatory Immunoglobulin G4–Related Pseudotumor

Immunoglobulin G4-Related Cardiovascular Diseases

“…Infiltration of IgG4-positive plasma cells often disturbs heart valve function, through stenosis and/or regurgitation. [20][21][22] Besiik and colleagues reported a case requiring both aortic and mitral valve replacement, 20) Maleszewski and colleagues presented two cases affecting the aortic valve, 21) and Yamauchi and colleagues reported a case with aortic regurgitation and heart block. 22) IgG4 infiltration sometimes forms a swollen tumorous lesion on a valve leaflet, and in each report valve replacement was selected as the most appropriate treatment.…”

IgG4-related disease of the mitral valve demonstrated by immunohistochemistry

“…Two prior cases reported IgG4-RD presenting with an intracardiac mass,2 3 and another reported an extensive cardiac pseudotumour infiltrating both the aortic and mitral leaflets requiring double valve replacement,4 but the current case is the first to demonstrably show mitral valve disease with immunohistochemistry. A review of the literature described two cases of IgG4-RD involving the aortic valve requiring valve replacement 5.…”

Successful Transcatheter Diagnosis and Medical Treatment of Right Atrial Involvement in IgG4-related Disease

“…5,6) Yamauchi, et al reported aortic valve (AV) involvement in IgG4-RD. 7) Thereafter, several cases of myocardial involvement in IgG4-RD with histological confirmation were reported, [8][9][10][11][12] but surgical resection or open biopsy of affected tissues was needed for diagnosis in all IgG4-RD cases with myocardial involvement. [5][6][7][8][9][10][11][12] In the present case, ICE-guided percutaneous transcatheter biopsy enabled tissue sampling from the cardiac mass, indicating that this technique is a safe and plausible approach for diagnosis of IgG4-RD, though its feasibility depends on localization of the mass.…”

“…1,2) Typical cardiovascular manifestations of IgG4-RD are periaortitis, coronary arteritis, and pericarditis. 3,4) Rare cases of myocardial involvement in IgG4-RD have been reported (Table I), [5][6][7][8][9][10][11][12] but surgical resection or open biopsy were required for the diagnosis in those cases.…”