Healed left-sided infective endocarditis: A clinicopathologic study of 59 patients

Roberts, William C.; Buchbinder, Neil A.

doi:10.1016/0002-9149(77)90038-8

Cited by 60 publications

(4 citation statements)

References 30 publications

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“…An acute endoca rditis may aiso exten d to the mitr al valve and cause leaflet or chor dae related insufficicncy.ln our patient the systolic murrnur caused by su bvalvular fibr omembran ous stenosis was known since childhood but never followed up or investigated because the patient always was in good physical condition. Most patients become elinical relevant by the age of3 0 yea rs or at over 60 years as in our case (8,9,13).…”

Section: Clinical Fiudi Nqssupporting

confidence: 60%

Uncommon Type of Mitral Insufficiency Caused by Perivalvular Communication Between Left Ventricle and Left Atrium

Hd¹,

Gramsch-Zabel²,

Horstkotte³

et al. 1990

Thorac cardiovasc Surg

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This case report describes a patient with an uncommon type of mitral incompetence caused by a perivalvular communication between the left ventricle (LV) and the left atrium (LA) masked by a considerable fibrotic subvalvular aortic stenosis, endocarditis and congestive heart failure (CHF). A 64 year old farmer with a history of a systolic murmur since childhood complaining of increasing fatigue and dyspnoea, temperature over 39 degrees C, and signs of CHF was admitted and transferred to a cardiological unit. Invasive examination and continuing clinical deterioration caused urgent transfer for surgery under suspicion of a decompensated hypertrophic obstructive cardiomyopathy. Clinical investigation revealed a decompensated subvalvular aortic stenosis and a mild mitral insufficiency. At surgery the advanced fibrotic subvalvular stenosis was resected. After coming off bypass severe mitral insufficiency was detected by intraoperative analysis of the simultaneous intracavitary-pressure tracings. A midsystolic maximum of a high V-wave of the LA-pressure tracing was suggestive of an unusual reason of the mitral insufficiency. Reexploration indicated a perivalvular broad communication from the LA groove to the LV with an otherwise normal mitral valve. The communication was closed using buttressed mattress-sutures. This uncommon type of mitral incompetence via a perivalvular LA-LV communication was probably caused by endocarditis and an intramyocardial abscess in the LA-wall which subendocardially led to LV-LA communication.

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Section: Clinical Fiudi Nqssupporting

confidence: 60%

Uncommon Type of Mitral Insufficiency Caused by Perivalvular Communication Between Left Ventricle and Left Atrium

Hd¹,

Gramsch-Zabel²,

Horstkotte³

et al. 1990

Thorac cardiovasc Surg

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“…As the primary cause of MR, the role of rheumatic fever has been reduced, but other causes such as IE, mitral valve prolapse, the rupture of chordae tendineae and papillary muscle are increasing these days. Regarding IE of the mitral valve, most cases are complicated with the rupture of chordae tendineae and valve perforation [1].…”

Section: Discussionmentioning

confidence: 99%

“…It has been reported that about 11% of IE was not associated with the previous history suggestive of clinical IE [1,5]. Although the vegetation and the rupture of chordae tendineae can be usually diagnosed with the echocardiography before operation, it is reported that approximately 20% cases of the perforation could not be detected despite the use of TEE [6].…”

Section: Discussionmentioning

confidence: 99%

Mitral regurgitation resulting from the consecutive multiple perforations by infective endocarditis mimicking the isolated anterior mitral cleft

Takaya

Takéuchi²,

Okamoto

et al. 2008

Journal of Cardiology

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A 60-year-old man, suffering from sustained cough and dyspnea on effort, was diagnosed as congestive heart failure. He did not yield the history of having fever or other inflammatory events. His physical examination disclosed a pan-systolic murmur at the apex. Transthoracic color Doppler echocardiography showed moderate to severe mitral regurgitation originated from the linear tear of the anterior mitral leaflet. The tear reached to the mid-portion of the leaflet just within the postero-medial commissure and the regurgitant flow convergence was not hemispheric, but box-like shaped, suggesting that the linear tear was the isolated mitral cleft. Transesophageal echocardiography showed the almost same findings and we found no other anomalies. Surgical treatment was selected to repair the mitral regurgitation. Under operation, we found three consecutive perforations located linearly in the anterior mitral leaflet. The mitral valve replaced with the prosthetic one. The pathological examination of the resected valve showed mucinous degeneration of the chordae tendineae and fibrinoid change without inflammatory cellular infiltration. These findings were compatible with the healed infective endocarditis. Here we experienced a curious case of mitral regurgitation, caused by consecutive three mitral perforations mimicking the isolated anterior mitral cleft.

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“…By history, none of our 5 patients had had an episode compatible with active infective endocarditis. To our knowledge, this condition does not result in near symmetrical fusion of each of the 3 aortic valve commissures, a circumstance which would have to exist if infective endocarditis were the culprit [12]. Thus, this possibility appears highly unlikely.…”

Section: Discussionmentioning

confidence: 99%

Clinical and Morphologic Features of the Congenitally Unicuspid Acommissural Stenotic and Regurgitant Aortic Valve

Roberts

Ko²

2006

Cardiology

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Healed left-sided infective endocarditis: A clinicopathologic study of 59 patients

Cited by 60 publications

References 30 publications

Uncommon Type of Mitral Insufficiency Caused by Perivalvular Communication Between Left Ventricle and Left Atrium

Uncommon Type of Mitral Insufficiency Caused by Perivalvular Communication Between Left Ventricle and Left Atrium

Mitral regurgitation resulting from the consecutive multiple perforations by infective endocarditis mimicking the isolated anterior mitral cleft

Clinical and Morphologic Features of the Congenitally Unicuspid Acommissural Stenotic and Regurgitant Aortic Valve

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