P1693 Mitral valve aneurysm complicating infective endocarditis

Abstract

Abstract Funding Acknowledgements Nothing to disclose Background Mitral valve aneurysm is an uncommon sequelae of infective endocarditis (IE), early diagnosis and timely intervention is of paramount importance to prevent aneurysm rupture and hemodynamic deterioration. Clinical presentation A 25-years old gentleman with no known past medical history, presented with a history of unexplained fever for the past month partially responding to antipyretics along with exertional dyspnea. On examination he had a blood pressure of 120/80 mmHg, a heart rate of 110 bpm, a temperature of 39oC, a harsh pansystolic murmur over the apex and early diastolic murmur over the second aortic area. Laboratory results revealed anaemia, leukocytosis elevated ESR and CRP and blood cultures were positive for streptococcus viridians. Electrocardiography showed sinus tachycardia. Methods and results Trans-Thoracic Echocardiography (TTE) revealed the presence of an echolucent cavity measured 1.6x1.6 cm overlying a perforation of the anterior mitral valve leaflet (AML) a long with two small vegetations attached to the AML at the perforation edge, largest measures 0.8cm. There was a severe mitral valve regurgitation. The aortic valve is thickened trileaflet with lack of diastolic cooptation and evidence of severe regurgitation. The left ventricle dimensions were dilated and function was reduced, estimated LVEF = 50%. 3DTrans-esophageal Echocardiography(TEE) was done for better visualization of the mitral valve. The cavity involved A2 scallop, it was perforated and communicating with the LA with an additional regurgitation jet. The aortic valve showed no detectable masses or abscesses. Accordingly, patient was diagnosed with infective enfocarditis complicated with AML perforation and aneurysm formation, anti-biotics were commenced and patient was referred for double valve replacement. Discussion Mitral valve aneurysm most commonly occurs secondary to infective endocarditis of the aortic valve, while our patient does not demonstrate evidence of vegetations at the aortic valve but he had an unhealthy valve with severe regurgitation jet that hits AML and might by a cause of hit lesion at the AML and eventually complicated by aneurysm formation. Discussion Echocardiography is a crucial imaging modality in patient with long standing fever and underlying valvular heart disease to rule out infective endocarditis. 3D-TEE is of added value along with TTE in better definition of vegetations, detection of infective endocarditis complication and it has a crucial role in proper diagnosis and surgical planning for better clinical outcomes. Abstract P1693 Figure. Mitral valve aneurysm