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Thong EHE, Kong WKF, Poh KK, Wong R, Chai P, Sia CH. Multimodal Cardiac Imaging in the Assessment of Patients Who Have Suffered a Cardioembolic Stroke: A Review. J Cardiovasc Dev Dis 2023; 11:13. [PMID: 38248883 PMCID: PMC10816708 DOI: 10.3390/jcdd11010013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Revised: 12/21/2023] [Accepted: 12/27/2023] [Indexed: 01/23/2024] Open
Abstract
Cardioembolic strokes account for 20-25% of all ischaemic strokes, with their incidence increasing with age. Cardiac imaging plays a crucial role in identifying cardioembolic causes of stroke, with early and accurate identification affecting treatment, preventing recurrence, and reducing stroke incidence. Echocardiography serves as the mainstay of cardiac evaluation. Transthoracic echocardiography (TTE) is the first line in the basic evaluation of structural heart disorders, valvular disease, vegetations, and intraventricular thrombus. It can be used to measure chamber size and systolic/diastolic function. Trans-oesophageal echocardiography (TOE) yields better results in identifying potential cardioembolic sources of stroke and should be strongly considered, especially if TTE does not yield adequate results. Cardiac computed tomography and cardiac magnetic resonance imaging provide better soft tissue characterisation, high-grade anatomical information, spatial and temporal visualisation, and image reconstruction in multiple planes, especially with contrast. These techniques are useful in cases of inconclusive echocardiograms and can be used to detect and characterise valvular lesions, thrombi, fibrosis, cardiomyopathies, and aortic plaques. Nuclear imaging is not routinely used, but it can be used to assess left-ventricular perfusion, function, and dimensions and may be useful in cases of infective endocarditis. Its use should be considered on a case-by-case basis. The accuracy of each imaging modality depends on the likely source of cardioembolism, and the choice of imaging approach should be tailored to individual patients.
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Affiliation(s)
| | - William K. F. Kong
- Department of Cardiology, National University Heart Centre Singapore, Singapore 119074, Singapore; (W.K.F.K.); (K.-K.P.); (R.W.); (P.C.)
| | - Kian-Keong Poh
- Department of Cardiology, National University Heart Centre Singapore, Singapore 119074, Singapore; (W.K.F.K.); (K.-K.P.); (R.W.); (P.C.)
| | - Raymond Wong
- Department of Cardiology, National University Heart Centre Singapore, Singapore 119074, Singapore; (W.K.F.K.); (K.-K.P.); (R.W.); (P.C.)
| | - Ping Chai
- Department of Cardiology, National University Heart Centre Singapore, Singapore 119074, Singapore; (W.K.F.K.); (K.-K.P.); (R.W.); (P.C.)
| | - Ching-Hui Sia
- Department of Cardiology, National University Heart Centre Singapore, Singapore 119074, Singapore; (W.K.F.K.); (K.-K.P.); (R.W.); (P.C.)
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2
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Mohanty V, Sharma SK, Deora S. Rare association of aneurysm of anterior mitral leaflet with bicuspid aortic valve. Ann Afr Med 2023; 22:554-556. [PMID: 38358161 PMCID: PMC10775931 DOI: 10.4103/aam.aam_142_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Revised: 11/02/2022] [Accepted: 11/18/2022] [Indexed: 02/16/2024] Open
Abstract
Mitral valve aneurysm is defined as outpouching of the mitral valve which expands in systole and collapse in diastole. It was first reported in 1729 by Morand. Most of the cases have been described in the African population. It is rare in the Indian population. Its chief presentations are congestive heart failure, palpitations, arrhythmia, or in rare cases an embolic phenomenon. It can be diagnosed either by echocardiography or cardiac imaging (magnetic resonance imaging/computed tomography). It can either occur as an isolated defect or with other associated valvular abnormalities. Here, we present a case of a 40-year-old male who was referred for the evaluation of palpitation who on the investigation was found to have a bicuspid aortic valve with severe Aortic Regurgitation (AR) along with aneurysm in the anterior mitral leaflet causing severe mitral regurgitation. This case highlights the importance of keeping a submitral aneurysm as a differential diagnosis for mitral regurgitation and searching for other associated valvular defects which may affect the management and treatment outcomes.
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Affiliation(s)
- Vivek Mohanty
- Department of Cardiology, All India Institute of Medical Science, Jodhpur, Rajasthan, India
| | - Shubham Kumar Sharma
- Department of Cardiology, All India Institute of Medical Science, Jodhpur, Rajasthan, India
| | - Surender Deora
- Department of Cardiology, All India Institute of Medical Science, Jodhpur, Rajasthan, India
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3
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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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4
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Andevari MY, Hali R. A Case of Perforated Infected Aneurysm of Mitral Valve Initially Misdiagnosed as a Tumoral Lesion. J Cardiovasc Echogr 2023; 33:105-107. [PMID: 37772048 PMCID: PMC10529294 DOI: 10.4103/jcecho.jcecho_27_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Accepted: 06/20/2023] [Indexed: 09/30/2023] Open
Affiliation(s)
| | - Reza Hali
- Department of Cardiology, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran
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5
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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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6
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Bansal S, Gupta P, Divani G, Popli K, Kisku N. Transoesophageal echocardiography in a middle-aged male with fever and rash. EUROPEAN HEART JOURNAL. ACUTE CARDIOVASCULAR CARE 2022; 11:950-952. [PMID: 36161477 DOI: 10.1093/ehjacc/zuac118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/17/2022] [Revised: 09/21/2022] [Accepted: 09/23/2022] [Indexed: 01/07/2023]
Affiliation(s)
- Sandeep Bansal
- Department of Cardiology, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
| | - Praveen Gupta
- Department of Cardiology, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
| | - Gauravkumar Divani
- Department of Cardiology, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
| | - Khushwant Popli
- Department of Cardiothoracic and Vascular Surgery, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
| | - Navnita Kisku
- Department of Cardiothoracic and Vascular Surgery, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
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7
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S. gallolyticus Aortic Valve Endocarditis with Mitral Valve Leaflet Aneurysm. Case Rep Cardiol 2022; 2022:3111032. [PMID: 36568525 PMCID: PMC9788890 DOI: 10.1155/2022/3111032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Accepted: 08/26/2022] [Indexed: 12/23/2022] Open
Abstract
S. gallolyticus is one of the pathogenic agents of endocarditis, and mitral valve aneurysm is a rare but potentially devastating complication. We present a case of S. gallolyticus aortic valve endocarditis with concomitant anterior mitral valve leaflet aneurysm. Patient underwent surgery before aneurysm perforation, and postoperative course was uneventful. Time of surgery is crucial to avoid severe complications due to aneurysm rupture.
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8
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Khoury M, Khiella M, Sharma GK, Mir WAY, Kovacs D, Khosla S, Reddy VK, Monahan S, KC S, Shrestha DB. Rupture of Both Left-Sided Valves Following Endocarditis Causing One Trouble After Another: A Case Report. Cureus 2022; 14:e21189. [PMID: 35165632 PMCID: PMC8837907 DOI: 10.7759/cureus.21189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Accepted: 01/12/2022] [Indexed: 12/05/2022] Open
Abstract
Despite the advances in managing left-sided infective endocarditis, complications are still not uncommon. Both aortic and mitral insufficiency can occur from infective endocarditis. In addition, valvular insufficiency due to rupture of valves presents acutely with cardiac decompensation and requires early surgical intervention. Here, we report a case of a 38-year-old intravenous drug user male with Group A Streptococcus-associated left-sided native valve infective endocarditis who presented with acute heart failure three months after his treatment of infective endocarditis. Infective endocarditis complications can lead to severe valve damage, causing acute heart failure, and may require immediate surgical intervention.
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9
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Vaideeswar P, Singaravel S, Butany J. Valvular heart disease. Cardiovasc Pathol 2022. [DOI: 10.1016/b978-0-12-822224-9.00008-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
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10
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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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11
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Raja J, Ponnuru S, Dharan BS, Suneel PR. Mitral kissing lesion with anterior mitral leaflet aneurysm in a child. Ann Card Anaesth 2021; 24:108-110. [PMID: 33938847 PMCID: PMC8081120 DOI: 10.4103/aca.aca_123_19] [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] [Indexed: 11/23/2022] Open
Abstract
Aortic valve endocarditis can lead to secondary involvement of aorto mitral curtain and the adjacent anterior mitral leaflet (AML). The secondary damage to AML is often caused by the infected diastolic jet of aortic regurgitation hitting the ventricular surface of the anterior mitral leaflet, or by the pronounced bacterial vegetation that prolapses from the aortic valve into the left ventricular outflow tract. This is called “kissing lesion”. We describe a case of infective endocarditis of aortic valve in a 13-year-old child causing secondary mitral valve involvement with AML perforation and aneurysm formation.
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Affiliation(s)
- Javid Raja
- Department of Cardiothoracic and Vascular Surgery, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, India
| | - Srawanthi Ponnuru
- Department of Cardiothoracic and Vascular Surgery, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, India
| | - Baiju S Dharan
- Department of Cardiothoracic and Vascular Surgery, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, India
| | - P R Suneel
- Department of Cardiac Anasthesia, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, India
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12
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Werner ME, Riezebos RK, Kuipers RS. A Perforated Mitral Valve Aneurysm: A Rare but Serious Complication of Aortic Valve Endocarditis Resulting From a Regurgitant Jet Lesion. Cureus 2020; 12:e11644. [PMID: 33376655 PMCID: PMC7755663 DOI: 10.7759/cureus.11644] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Infective endocarditis has high morbidity and mortality rates. The aortic valve is most often affected in native valve endocarditis. Complications of aortic valve endocarditis range from local abscess and fistula formation, systemic complications secondary to thromboembolism and septic embolization, to congestive heart failure resulting from conduction system involvement and valve damage. A rare complication of aortic valve endocarditis is the occurrence of a ‘jet lesion’ on the mitral valve. Such a lesion, caused by an impinging regurgitant jet stream from a damaged aortic valve, can become directly and indirectly inoculated and evolve into a local infected aneurysm which might eventually rupture causing acute severe congestive heart failure and/or peripheral thromboembolism. We present the case of a 63-year-old man who presented with aortic valve endocarditis complicated by a perforated mitral valve aneurysm, congestive heart failure, and peripheral thromboembolism.
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13
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Agarwal A, Nair KKM, Valaparambil A. Mitral valve leaflet diverticulum with vegetation-a rare complication in rheumatic heart disease. Indian J Thorac Cardiovasc Surg 2020; 37:326-328. [PMID: 33967424 DOI: 10.1007/s12055-020-01066-0] [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: 07/09/2020] [Revised: 09/16/2020] [Accepted: 09/21/2020] [Indexed: 10/23/2022] Open
Abstract
Diverticulum of mitral leaflet is a rare complication, which is recognized by its central clearing with characteristic diastolic collapse and systolic expansion on echocardiogram. It is found to be commonly associated with infective endocarditis while various other mechanisms of its formation have been suggested. The present case with an underlying history of rheumatic heart disease complicated by infective endocarditis well demonstrates the formation of mitral leaflet diverticulum and its possible complications. Surgical findings revealed diverticulum of the anterior mitral leaflet, and the patient underwent double valve replacement.
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Affiliation(s)
- Ankur Agarwal
- Department of Cardiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala 695011 India
| | - Krishna Kumar Mohanan Nair
- Department of Cardiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala 695011 India
| | - Ajitkumar Valaparambil
- Department of Cardiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala 695011 India
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14
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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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15
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Galzerano D, Kinsara AJ, Di Michele S, Vriz O, Fadel BM, Musci RL, Galderisi M, Al Sergani H, Colonna P. Three dimensional transesophageal echocardiography: a missing link in infective endocarditis imaging? Int J Cardiovasc Imaging 2020; 36:403-413. [PMID: 31902093 DOI: 10.1007/s10554-019-01747-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2019] [Accepted: 12/09/2019] [Indexed: 10/25/2022]
Abstract
The role of two dimensional (2D) echocardiography (ECHO) for the diagnosis and clinical decision making in infective endocarditis (IE) has been extensively studied and described in the medical literature. Some reports have demonstrated the incremental value of three dimensional (3D) transesophageal (TE) ECHO in the setting of IE. However, a systematic review focusing on the role of 3D imaging is lacking. In this manuscript, we examine the role of 3D TE ECHO in the diagnosis of IE. IE is a challenging disease in which 2D transthoracic (TT) and TE ECHO have complementary roles and are unequivocally the mainstay of diagnostic imaging. Still, 2D imaging has important limitations. Technological advances in 3D imaging allow for the reconstruction of real-time anatomical images of cardiac structure and function. 3D imaging has emerged as a diagnostic technique that overcame some of the limitations of 2D ECHO. Currently, both transthoracic and transesophageal echocardiography transducers are able to generate 3D images. However, 3D TE ECHO provides images of a higher quality in comparison to 3D TT ECHO, and is the best echocardiographic modality able to allow for a detailed anatomical imaging. 3D TE ECHO may represent the key adjunctive echocardiographic technique being able to positively impact on IE-related surgical planning and intervention and to facilitate the interaction between the surgeon and the imaging specialist. Importantly, 3D TE ECHO is not the recommended initial modality of choice for the diagnosis of IE; however, in highly specialized centers, it has become an important complementary technique when advanced surgical planning is required. Furthermore, anatomical imaging has become the link between the different techniques that play a role in IE imaging. In fact, both computed tomography and magnetic resonance allow three dimensional reconstruction. An important future goal should allow for the fusion among various imaging modalities. Our review highlights the role of 3D TE ECHO in IE imaging and emphasize where it offers incremental value.
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Affiliation(s)
- Domenico Galzerano
- The Heart Centre, King Faisal Specialist Hospital & Research Center, Riyadh, Saudi Arabia. .,College of Medicine, Alfaisal University, Riyadh, Saudi Arabia.
| | - Abdulhalim J Kinsara
- Ministry of National Guard Health Affair, COM-WR, King Abdullah International Research Center, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia
| | - Sara Di Michele
- Divisione di Cardiologia, Ospedale San Filippo Neri, Rome, Italy
| | - Olga Vriz
- The Heart Centre, King Faisal Specialist Hospital & Research Center, Riyadh, Saudi Arabia
| | - Bahaa M Fadel
- The Heart Centre, King Faisal Specialist Hospital & Research Center, Riyadh, Saudi Arabia.,College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
| | - Rita Leonarda Musci
- Ecocardiografia Basale e Complessa, Azienda Ospedaliera Universitaria, Policlinico di Bari, Bari, Italy
| | - Maurizio Galderisi
- Department of Cardiology, Cardiac Surgery and Cardiovascular Emergencies, Federico II, University of Naples, Naples, Italy
| | - Hani Al Sergani
- The Heart Centre, King Faisal Specialist Hospital & Research Center, Riyadh, Saudi Arabia
| | - Paolo Colonna
- Ecocardiografia Basale e Complessa, Azienda Ospedaliera Universitaria, Policlinico di Bari, Bari, Italy
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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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Archontakis S, Aggeli C, Dimitroglou Y, Koumallos N, Demosthenous M, Sideris K, Tousoulis D, Triantafyllou G, Sideris S. A perforated mitral valve anterior leaflet aneurysm in a patient presenting with acute pulmonary oedema. Hellenic J Cardiol 2019; 61:226-228. [PMID: 31756492 DOI: 10.1016/j.hjc.2019.10.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Revised: 10/14/2019] [Accepted: 10/16/2019] [Indexed: 11/28/2022] Open
Affiliation(s)
- Stefanos Archontakis
- First Cardiology Division, University of Athens, Hippokration General Hospital, Athens, Greece
| | - Constantina Aggeli
- First Cardiology Division, University of Athens, Hippokration General Hospital, Athens, Greece
| | - Yannis Dimitroglou
- First Cardiology Division, University of Athens, Hippokration General Hospital, Athens, Greece
| | - Nikolas Koumallos
- Department of Cardiac Surgery, Hippokration General Hospital, Athens, Greece
| | | | | | - Dimitrios Tousoulis
- First Cardiology Division, University of Athens, Hippokration General Hospital, Athens, Greece
| | | | - Skevos Sideris
- Department of Cardiology, Hippokration General Hospital, Athens, Greece.
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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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19
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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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20
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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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21
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Manrique R, Alzueta A, Ramírez JL, Iribarren MJ, Montenegro R, Rábago G. Reparación transaórtica de un aneurisma del velo anterior mitral como complicación de una endocarditis bacteriana. CIRUGIA CARDIOVASCULAR 2018. [DOI: 10.1016/j.circv.2018.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
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22
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Abstract
PURPOSE OF REVIEW In this review, we examine the central role of echocardiography in the diagnosis, prognosis, and management of infective endocarditis (IE). RECENT FINDINGS 2D transthoracic echocardiography (TTE) and transesophageal echocardiography TEE have complementary roles and are unequivocally the mainstay of diagnostic imaging in IE. The advent of 3D and multiplanar imaging have greatly enhanced the ability of the imager to evaluate cardiac structure and function. Technologic advances in 3D imaging allow for the reconstruction of realistic anatomic images that in turn have positively impacted IE-related surgical planning and intervention. CT and metabolic imaging appear to be emerging as promising ancillary diagnostic tools that could be deployed in select scenarios to circumvent some of the limitations of echocardiography. Our review summarizes the indispensable and central role of various echocardiographic modalities in the management of infective endocarditis. The complementary role of 2D TTE and TEE are discussed and areas where 3D TEE offers incremental value highlighted. An algorithm summarizing a contemporary approach to the workup of endocarditis is provided and major societal guidelines for timing of surgery are reviewed.
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23
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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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24
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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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25
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Olmos C, Vilacosta I, López J, Sarriá C, Ferrera C, San Román JA. Actualización en endocarditis protésica. CIRUGIA CARDIOVASCULAR 2017. [DOI: 10.1016/j.circv.2016.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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26
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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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27
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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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28
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Tomsic A, Li WWL, van Paridon M, Bindraban NR, de Mol BAJM. Infective Endocarditis of the Aortic Valve with Anterior Mitral Valve Leaflet Aneurysm. Tex Heart Inst J 2016; 43:345-9. [PMID: 27547149 DOI: 10.14503/thij-15-5322] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Mitral valve leaflet aneurysm is a rare and potentially devastating complication of aortic valve endocarditis. We report the case of a 48-year-old man who had endocarditis of the native aortic valve and a concomitant aneurysm of the anterior mitral valve leaflet. Severe mitral regurgitation occurred after the aneurysm perforated. The patient showed no signs of heart failure and completed a 6-week regimen of antibiotic therapy before undergoing successful aortic and mitral valve replacement. In addition to the patient's case, we review the relevant medical literature.
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MESH Headings
- Adult
- Aged
- Aneurysm, Infected/diagnostic imaging
- Aneurysm, Infected/microbiology
- Aneurysm, Infected/therapy
- Aneurysm, Ruptured/diagnostic imaging
- Aneurysm, Ruptured/microbiology
- Aneurysm, Ruptured/therapy
- Anti-Bacterial Agents/administration & dosage
- Aortic Valve/diagnostic imaging
- Aortic Valve/microbiology
- Aortic Valve/surgery
- Drug Administration Schedule
- Echocardiography, Transesophageal
- Endocarditis, Bacterial/diagnostic imaging
- Endocarditis, Bacterial/microbiology
- Endocarditis, Bacterial/therapy
- Female
- Heart Aneurysm/diagnostic imaging
- Heart Aneurysm/microbiology
- Heart Aneurysm/therapy
- Heart Valve Diseases/diagnostic imaging
- Heart Valve Diseases/microbiology
- Heart Valve Diseases/therapy
- Heart Valve Prosthesis Implantation
- Humans
- Male
- Middle Aged
- Mitral Valve/diagnostic imaging
- Mitral Valve/microbiology
- Mitral Valve/surgery
- Mitral Valve Insufficiency/diagnostic imaging
- Mitral Valve Insufficiency/microbiology
- Mitral Valve Insufficiency/surgery
- Streptococcal Infections/diagnostic imaging
- Streptococcal Infections/microbiology
- Streptococcal Infections/therapy
- Streptococcus gordonii/drug effects
- Streptococcus gordonii/isolation & purification
- Treatment Outcome
- Young Adult
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29
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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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30
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Vilacosta I, Olmos C, de Agustín A, López J, Islas F, Sarriá C, Ferrera C, Ortiz-Bautista C, Sánchez-Enrique C, Vivas D, San Román A. The diagnostic ability of echocardiography for infective endocarditis and its associated complications. Expert Rev Cardiovasc Ther 2015; 13:1225-36. [PMID: 26471429 DOI: 10.1586/14779072.2015.1096780] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Echocardiography, transthoracic and transoesophageal, plays a key role in the diagnosis and prognosis assessment of patients with infective endocarditis. It constitutes a major Duke criterion and is pivotal in treatment guiding. Seven echocardiographic findings are major criteria in the diagnosis of infective endocarditis (IE) (vegetation, abscess, pseudoaneurysm, fistulae, new dehiscence of a prosthetic valve, perforation and valve aneurysm). Echocardiography must be performed as soon as endocarditis is suspected. Transoesophageal echocardiography should be done in most cases of left-sided endocarditis to better define the anatomic lesions and to rule out local complications. Transoesophageal echocardiography is not necessary in isolated right-sided native valve IE with good quality transthoracic examination and unequivocal echocardiographic findings. Echocardiography is a very useful tool to assess the prognosis of patients with IE at any time during the course of the disease. Echocardiographic predictors of poor outcome include presence of periannular complications, prosthetic dysfunction, low left ventricular ejection fraction, pulmonary hypertension and very large vegetations.
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Affiliation(s)
- Isidre Vilacosta
- a 1 Instituto Cardiovascular, Hospital Clínico San Carlos, Madrid, Spain
| | - Carmen Olmos
- a 1 Instituto Cardiovascular, Hospital Clínico San Carlos, Madrid, Spain
| | - Alberto de Agustín
- a 1 Instituto Cardiovascular, Hospital Clínico San Carlos, Madrid, Spain
| | - Javier López
- b 2 Instituto de Ciencias del Corazón (ICICOR), Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | - Fabián Islas
- a 1 Instituto Cardiovascular, Hospital Clínico San Carlos, Madrid, Spain
| | - Cristina Sarriá
- c 3 Servicio de Medicina Interna-Infecciosas, Instituto de Investigación Sanitaria del Hospital Universitario de la Princesa, Madrid, Spain
| | - Carlos Ferrera
- a 1 Instituto Cardiovascular, Hospital Clínico San Carlos, Madrid, Spain
| | - Carlos Ortiz-Bautista
- b 2 Instituto de Ciencias del Corazón (ICICOR), Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | | | - David Vivas
- a 1 Instituto Cardiovascular, Hospital Clínico San Carlos, Madrid, Spain
| | - Alberto San Román
- b 2 Instituto de Ciencias del Corazón (ICICOR), Hospital Clínico Universitario de Valladolid, Valladolid, Spain
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31
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Habib G, Lancellotti P, Antunes MJ, Bongiorni MG, Casalta JP, Del Zotti F, Dulgheru R, El Khoury G, Erba PA, Iung B, Miro JM, Mulder BJ, Plonska-Gosciniak E, Price S, Roos-Hesselink J, Snygg-Martin U, Thuny F, Tornos Mas P, Vilacosta I, Zamorano JL. 2015 ESC Guidelines for the management of infective endocarditis: The Task Force for the Management of Infective Endocarditis of the European Society of Cardiology (ESC). Endorsed by: European Association for Cardio-Thoracic Surgery (EACTS), the European Association of Nuclear Medicine (EANM). Eur Heart J 2015; 36:3075-3128. [PMID: 26320109 DOI: 10.1093/eurheartj/ehv319] [Citation(s) in RCA: 3073] [Impact Index Per Article: 341.4] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
MESH Headings
- Acute Kidney Injury/diagnosis
- Acute Kidney Injury/therapy
- Ambulatory Care
- Aneurysm, Infected/diagnosis
- Aneurysm, Infected/therapy
- Anti-Bacterial Agents/therapeutic use
- Antibiotic Prophylaxis
- Arrhythmias, Cardiac/diagnosis
- Arrhythmias, Cardiac/therapy
- Clinical Laboratory Techniques
- Critical Care
- Cross Infection/etiology
- Dentistry, Operative
- Diagnostic Imaging/methods
- Embolism/diagnosis
- Embolism/therapy
- Endocarditis/diagnosis
- Endocarditis/therapy
- Endocarditis, Non-Infective/diagnosis
- Endocarditis, Non-Infective/therapy
- Female
- Fibrinolytic Agents/therapeutic use
- Heart Defects, Congenital
- Heart Failure/diagnosis
- Heart Failure/therapy
- Heart Valve Diseases/diagnosis
- Heart Valve Diseases/therapy
- Humans
- Long-Term Care
- Microbiological Techniques
- Musculoskeletal Diseases/diagnosis
- Musculoskeletal Diseases/microbiology
- Musculoskeletal Diseases/therapy
- Myocarditis/diagnosis
- Myocarditis/therapy
- Neoplasms/complications
- Nervous System Diseases/diagnosis
- Nervous System Diseases/microbiology
- Nervous System Diseases/therapy
- Patient Care Team
- Pericarditis/diagnosis
- Pericarditis/therapy
- Postoperative Complications/etiology
- Postoperative Complications/prevention & control
- Pregnancy
- Pregnancy Complications, Cardiovascular/diagnosis
- Pregnancy Complications, Cardiovascular/therapy
- Prognosis
- Prosthesis-Related Infections/diagnosis
- Prosthesis-Related Infections/therapy
- Recurrence
- Risk Assessment
- Risk Factors
- Splenic Diseases/diagnosis
- Splenic Diseases/therapy
- Thoracic Surgical Procedures
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32
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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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33
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Zarrini P, Elboudwarej O, Luthringer D, Siegel R. Rare Mycotic Aneurysm of the Mitral Valve without Aortic Valve Involvement. Echocardiography 2015; 32:1428-31. [PMID: 25881967 DOI: 10.1111/echo.12942] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Mycotic aneurysms can be a rare, but serious complication of infectious endocarditis. We report the case of a 20-year-old woman who presented with fever and malaise from streptococcal bacteremia and found to have vegetation on the anterior leaflet of the mitral valve. On follow-up visit, the patient was noted to have a mycotic aneurysm of the anterior mitral valve without aortic involvement. Her clinical course was complicated by mitral valve chordal rupture, severe mitral regurgitation, and dyspnea from severe mitral regurgitation for which she underwent successful surgical repair of the mitral valve.
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Affiliation(s)
- Parham Zarrini
- The Heart Institute, Cedars Sinai Medical Center, Los Angeles, California
| | - Omeed Elboudwarej
- The Heart Institute, Cedars Sinai Medical Center, Los Angeles, California
| | - Daniel Luthringer
- The Heart Institute, Cedars Sinai Medical Center, Los Angeles, California
| | - Robert Siegel
- The Heart Institute, Cedars Sinai Medical Center, Los Angeles, California
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34
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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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35
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Zegrí I, Moñivas V, Mingo S, Garcia-Montero C, Cavero MA. Ruptured aneurysm of anterior mitral leaflet in aortic valve infective endocarditis. Echocardiography 2014; 32:720-2. [PMID: 25365965 DOI: 10.1111/echo.12831] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Affiliation(s)
- Isabel Zegrí
- Echocardiography Laboratory, Department of Cardiology, Hospital Universitario Puerta de Hierro, Madrid, Spain
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36
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Zhang H, Chen H, Sun X, Yang S, Wang C. Repair for mitral valve aneurysm using autologous pericardium: a case of our experience. J Cardiothorac Surg 2014; 9:148. [PMID: 25230935 PMCID: PMC4182794 DOI: 10.1186/s13019-014-0148-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2014] [Accepted: 08/18/2014] [Indexed: 11/29/2022] Open
Abstract
Mitral Valve Aneurysm (MVA) is rarely reported and occurs most in association with infective endocarditis of the aortic valve. In our case, the 46-yr-old Chinese man was referred to our hospital with dyspnea and orthopnea. Transesophageal echocardiography during operation revealed a localized, thin-walled saccular structure in the anterior leaflet that bulged into the left atrium, and severe mitral and aortic regurgitation. Aortic valve was replaced with mechanical prostheses and mitral valve was repaired with autologous pericardium. Transesophageal echocardiography during operation and transthoracic echocardiography 3 months later showed mild regurgitation.
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37
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Kharwar RB, Mohanty A, Sharma A, Narain VS, Sethi R. Ruptured anterior mitral leaflet aneurysm in aortic valve infective endocarditis--evaluation by three-dimensional echocardiography. Echocardiography 2014; 31:E72-6. [PMID: 24749164 DOI: 10.1111/echo.12449] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Ruptured aneurysm of the anterior mitral leaflet is a rare but a devastating complication secondary to aortic valve infective endocarditis. We report a case of 30-year-old male with native aortic valve endocarditis who was referred to us for evaluation of worsening of heart failure after an initial period of responsiveness to antibiotics. Detailed evaluation with two-dimensional and three-dimensional transthoracic echocardiography revealed ruptured anterior mitral leaflet aneurysm with severe eccentric mitral regurgitation along with a large vegetation on the aortic valve. The patient underwent successful surgical closure of the defect along with aortic valve replacement.
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38
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Guler A, Karabay CY, Gursoy OM, Guler Y, Candan O, Akgun T, Bulut M, Pala S, Izgi AI, Esen AM, Kirma C, Ozkan M. Clinical and echocardiographic evaluation of mitral valve aneurysms: a retrospective, single center study. Int J Cardiovasc Imaging 2014; 30:535-41. [DOI: 10.1007/s10554-014-0365-4] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2013] [Accepted: 01/08/2014] [Indexed: 10/25/2022]
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Successful Repair of a Mitral Valve Aneurysm With Cleft of Anterior Mitral Leaflet in an Adult. Ann Thorac Surg 2013; 96:2238-40. [DOI: 10.1016/j.athoracsur.2013.04.110] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2013] [Revised: 04/02/2013] [Accepted: 04/08/2013] [Indexed: 11/24/2022]
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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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Teoh J, Hoey E, Pakala V, Simpson H, Panting J. Multidetector CT assessment of caseous mitral valve calcification with evidence of fistulous communication to the left ventricle. Clin Radiol 2013; 68:976-9. [DOI: 10.1016/j.crad.2013.02.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2012] [Revised: 01/29/2013] [Accepted: 02/07/2013] [Indexed: 10/26/2022]
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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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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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Habib G, Badano L, Tribouilloy C, Vilacosta I, Zamorano JL, Galderisi M, Voigt JU, Sicari R, Cosyns B, Fox K, Aakhus S. Recommendations for the practice of echocardiography in infective endocarditis. EUROPEAN JOURNAL OF ECHOCARDIOGRAPHY 2011; 11:202-19. [PMID: 20223755 DOI: 10.1093/ejechocard/jeq004] [Citation(s) in RCA: 332] [Impact Index Per Article: 25.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Echocardiography plays a key role in the assessment of infective endocarditis (IE). It is useful for the diagnosis of endocarditis, the assessment of the severity of the disease, the prediction of short- and long-term prognosis, the prediction of embolic events, and the follow-up of patients under specific antibiotic therapy. Echocardiography is also useful for the diagnosis and management of the complications of IE, helping the physician in decision-making, particularly when a surgical therapy is considered. Finally, intraoperative echocardiography must be performed in IE to help the surgeon in the assessment and management of patients with IE during surgery. The current 'recommendations for the practice of echocardiography in infective endocarditis' aims to provide both an updated summary concerning the value and limitations of echocardiography in IE, and clear and simple recommendations for the optimal use of both transthoracic and transoesophageal echocardiography in IE.
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Affiliation(s)
- Gilbert Habib
- Service de Cardiologie, CHU La Timone, Boulevard Jean Moulin, Marseille, France.
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Ruparelia N, Lawrence D, Elkington A. Bicuspid aortic valve endocarditis complicated by mitral valve aneurysm. J Card Surg 2011; 26:284-6. [PMID: 21447085 DOI: 10.1111/j.1540-8191.2011.01243.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
We describe a case of mitral valve aneurysm associated with concomitant aortic valve endocarditis. Aneurysms appear as a localized saccular bulge of the anterior leaflet into the left atrium and thus are often misdiagnosed as mitral valve prolapse, myxomatous mitral valve, or atrial myxoma. The presentation and management of mitral valve aneurysms are the subject of this case report.
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Affiliation(s)
- Neil Ruparelia
- Department of Cardiology, Royal Berkshire Hospital, Berkshire, United Kingdom.
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Tewari S, Moorthy N, Sinha N. Ruptured Mitral Valve Aneurysm: An Uncommon Cause of Acute Dyspnoea. Echocardiography 2010; 27:E119-21. [DOI: 10.1111/j.1540-8175.2010.01185.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Sareyyupoglu B, Schaff HV, Suri RM, Connolly HM, Daly RC, Orszulak TA. Safety and durability of mitral valve repair for anterior leaflet perforation. J Thorac Cardiovasc Surg 2010; 139:1488-93. [DOI: 10.1016/j.jtcvs.2009.07.040] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2009] [Revised: 06/18/2009] [Accepted: 07/16/2009] [Indexed: 11/27/2022]
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48
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Habib G, Hoen B, Tornos P, Thuny F, Prendergast B, Vilacosta I, Moreillon P, de Jesus Antunes M, Thilen U, Lekakis J, Lengyel M, Müller L, Naber CK, Nihoyannopoulos P, Moritz A, Luis Zamorano J. Guía de práctica clínica para prevención, diagnóstico y tratamiento de la endocarditis infecciosa (nueva versión 2009). Rev Esp Cardiol 2009. [DOI: 10.1016/s0300-8932(09)73131-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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49
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Habib G, Hoen B, Tornos P, Thuny F, Prendergast B, Vilacosta I, Moreillon P, de Jesus Antunes M, Thilen U, Lekakis J, Lengyel M, Müller L, Naber CK, Nihoyannopoulos P, Moritz A, Zamorano JL, Vahanian A, Auricchio A, Bax J, Ceconi C, Dean V, Filippatos G, Funck-Brentano C, Hobbs R, Kearney P, McDonagh T, McGregor K, Popescu BA, Reiner Z, Sechtem U, Sirnes PA, Tendera M, Vardas P, Widimsky P, Vahanian A, Aguilar R, Bongiorni MG, Borger M, Butchart E, Danchin N, Delahaye F, Erbel R, Franzen D, Gould K, Hall R, Hassager C, Kjeldsen K, McManus R, Miro JM, Mokracek A, Rosenhek R, San Roman Calvar JA, Seferovic P, Selton-Suty C, Uva MS, Trinchero R, van Camp G. 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. [PMID: 19713420 DOI: 10.1093/eurheartj/ehp285] [Citation(s) in RCA: 1227] [Impact Index Per Article: 81.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Affiliation(s)
- Gilbert Habib
- Service de Cardiologie, CHU La Timone, Bd Jean Moulin, 13005 Marseille, France.
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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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