Mitral Valve Replacement in Idiopathic Eosinophilic Endocarditis Without Peripheral Eosinophilia

Abstract

Idiopathic hypereosinophilic syndrome (IHS) is a rare systemic disease than can cause multiple organ failure by eosinophilic infiltration. Cardiac involvement is characterized by endocardial fibrosis and overlying thrombus leading to restrictive cardiomyopathy and valvular dysfunction. The absence of peripheral eosinophilia does not exclude eosinophilic cardiac involvement. Surgical experience of patients with mitral dysfunction caused by this syndrome is limited and valvular replacement is most often performed. Mechanical valvular replacement has a high incidence of recurrent obstructive thrombosis and replacement by bioprosthesis is recommended despite associated restrictive cardiomyopathy. This report describes a patient who presented mitral insufficiency caused by eosinophilic endocarditis without peripheral eosinophilia who underwent mitral valve replacement.

Eosinophilic cardiac disease: Molecular, clinical and imaging aspects

“…Indeed, after endomyocardectomy, 70% of patients have revealed improvements of symptoms [55]. When valvular regurgitation is important, valvular surgery may be considered, and bioprosthetic valve replacement is commonly preferred to mechanical prosthesis [56,57]. Indeed, recurrent +Model ACVD-802; No.…”

Unusual case of aortic valve involvement in patient with Löffler’s Endomyocarditis: management, follow-up and short review of the literature

“…Mostly, mechanical valvular replacement is complicated with recurrent thrombosis of the valves despite the adequate anticoagulation therapy, additionally, bioprosthetic valves degenerated with thrombosis and/or fibrosis. Generally, additional difficulties with surgical approaches occur and surgical therapy seems useless in precluding the worse prognosis [14,15]. After the administration of anticoagulation and chemotherapy with fludarabine and melphalan rapid and extended regression of the left ventricular obliteration, was just reported [16].…”

Löffler endocarditis: a rare cause of acute cardiac failure

“…Thromboembolic disease involving the cardiac chambers and/or both the venous and arterial vessels is not infrequent [2]. Cardiac involvement occurs in more than 75% of patients with HES and is the major cause of morbidity and mortality [6]. Cardiac involvement in HES usually follows three stages.…”

“…Valve replacement is most often performed but the choice between a mechanical or biological prosthesis in this setting poses a difficult problem. Mechanical valves have a high incidence of recurrent obstructive thrombosis and therefor a bioprosthesis is recommended despite associated restrictive cardiomyopathy [6]. …”