P79 MITRAL VALVE ENDOCARDITIS COMPLICATED BY INFERIOR INFARCT AND MULTIPLE DISTAL EMBOLICATIONS

Abstract

Abstract A 41–year–old woman with history of drug addiction was ammitted at emergency department (ED) with the following symptoms: hyperpyrexia, shaking chills asthenia and anorexia for about 10 days; the hematochemical tests performed in urgency showed an increasing inflammatory markers and severe anemia. On suspicion of infective endocarditis, a transthoracic echocadiogram was performed which revealed a mobile isoechoic mass adhered to the anterior mitral leaflet (LAM), compatible in the first hypothesis with endocardiac vegetation. Hemocultures were drawn and empiric antibiotic therapy was setted. Following clinical conditions’s worsening, the patient underwent contrast–free total body Computed Tomography (CT) with the detection of multiple pulmonary, splenic and renal septic emboli associated with a cerebral hemorrhagic focus. Transesophageal echocardiography (TEE) confirmed the presence of a 29 mm mobile vegetation on the atrial side of the LAM and the LAM’s perforation at the A3 level with associated severe eccentric regurgitation jet. Therefore, during hospitalization, coronary septic embolization was suspected due to the onset of a severe epigastric pain and the electrocardiographic finding of ST–elevation in the inferior leads associated with troponin’s increase. In consideration of the high bleeding risk and the septic state, conservative therapy was indicated. After a month of targeted antibiotic therapy, once clinical stabilization was obtained, a control TEE was performed and showed the disappearance of the endocardial vegetation and the persistence of the valve flap perforation and the eccentric jet. Once the regression of the septic state, a coronarographic study was performed and it showed no significant stenosis. The patient underwent mitral valve plastic surgery with the direct suture of the LAM and ring implantation in mini–thoracotomy. After a short period in intensive care, she continued her hospitalization in cardiac surgery department without complications. Careful clinical management of the acute phase and antibiotic therapy, empirical and targeted, allowed the patient to undergo cardiac surgery in the best possible conditions, reducing the risk of complications.