Giant Vegetation in a Mitral Prosthetic Valve

Abstract

Forty eight-year-old-woman with history of mechanical prosthetic replacement of mitral and aortic valves in February 2005, came to emergency department with fatigue, weakness and chills since two months and dyspnea and edema of lower limbs from three days. The physical examination revealed jugular engorgement, peripheral edema, normal prosthetic clicks and mitral regurgitant murmur II/IV. The laboratory showed anemia, leucocytosis, high NT-pro BNP and high sensitive C-reactive protein. The chest X-ray with cardio megaly and veno capillary pulmonary hypertension (Figure 1). The transesophageal echocardiogram demonstrated giant vegetation in the trial side of the mitral prosthesis that prolapsed into the ventricle during diastole and small vegetations in prosthetic aortic valve (Figure 2). The blood culture showed streptococcus mitis.