Mitral Valve Perforation Research Articles

An unusual anterior mitral leaflet perforation in a patient with no infective endocarditis: a case report

Abstract Background Mitral valve perforation refers to the occurrence of cracks or openings in the structure of the mitral valve, allowing blood to escape through these gaps. Typically, this is caused by infective endocarditis and the most common site is the anterior leaflet. However, it is crucial to explore other potential causes of valve damage, particularly when conventional risk factors are not apparent. Case presentation We present a case of a middle-aged male patient who developed mitral valve perforation because of aortic valve regurgitation in the absence of infective endocarditis. Conclusion Exploring such rare cases contributes to a deeper understanding of valvular diseases and enhances clinical decision making for effective management.

P 005: Supramitral membrane with superimposed old infective endocarditis complicated by posterior mitral valve perforation

P 005: Supramitral membrane with superimposed old infective endocarditis complicated by posterior mitral valve perforation

Rare complications of infective endocarditis in marfan-like morphotype: diagnosis of multiple mitral valve aneurysms and aortic root abscess using three-dimensional transesophageal echocardiography

Mitral valve aneurysm (MVA) is characterized by a saccular outpouching of the mitral leaflet, and it represents a rare condition typically associated with aortic valve endocarditis. Three-Dimensional Transesophageal Echocardiography (3D-TEE) serves as an effective tool for detecting the presence of MVA and its potential complications. In this report, we present a case involving a young man with striking images of bicuspid aortic valve endocarditis complicated by an aortic root abscess and multiple perforated mitral valve aneurysms, diagnosed using 3D TEE. This case suggests the uncommon coexistence of Marfan like morphotype, bicuspid aortic valve, and infective endocarditis as a triple mechanism in the occurrence of MVA. It underscores the significance of early and accurate imaging diagnosis for facilitating prompt surgical intervention.

Abstract 18142: A Silent Heart Break: An Uncommon Case of Silent Mitral Valve Perforation Secondary to Infective Endocarditis

Introduction: Infective Endocarditis (IE) is an endocardial surface infection of the heart which may lead to valve damage and if severe, this may even lead to valve perforation which can cause significant regurgitation and cardiac function compromise. We present an uncommon case of IE complicated by mitral valve perforation. Case presentation: A 46-year old male with AIDS and polysubstance use was brought to the ED from a shelter after exhibiting erratic behavior with confusion. On exam, he was febrile and tachycardic. Lab data pertinent for lacticaemia and leukocytosis. Blood cultures grew Streptococcus Pneumoniae. MRI Brain was unremarkable. Echocardiography was unremarkable. Antibiotic was initiated leading to marked improvement in patient’s mental status. Despite clinical improvement, days into hospital course, a new holosystolic murmur was audible with left axillary radiation necessitating a repeat echocardiogram which revealed moderate-to-severe mitral eccentric jet regurgitation concerning for anterior leaflet perforation. He remained euvolemic without symptoms of heart failure and was subsequently transferred to a tertiary facility where a mitral valve surgery replacement was scheduled. Discussion: Most patients with infective endocarditis have no preceding valvular abnormality. This case is unusual as there was valvular perforation with no evidence of valvular involvement on prior imaging which could possibly be as a result of invasive streptococcus pneumonia IE potentially coexisting with bacterial meningitis which carries a high mortality rate. Invasive streptococcus pneumonia is an unusual cause of IE since wide availability of antibiotics and vaccines. This case reminds us of the need of thorough physical exam and sequential imaging in such immunocompromised patient groups. Conclusions: A high suspicion for mitral valve perforation should be maintained in patients with invasive streptococcus pneumoniae and new cardiac murmur.

COVID-19-associated MRSA infective endocarditis and mitral valve perforation: a case report

BackgroundCoronavirus disease 2019 (COVID-19) has emerged as a global pandemic, leading to significant morbidity and mortality. The interplay between COVID-19 and other medical conditions can complicate diagnosis and management, necessitating further exploration.Case presentationThis case report presents a patient with COVID-19 who developed infective endocarditis (IE) and mitral valve perforation caused by methicillin-resistant Staphylococcus aureus on a native mitral valve. Notably, the patient did not exhibit typical IE risk factors, such as intravenous drug use. However, he did possess risk factors for bacteremia, including a history of diabetes mellitus and recent steroid use due to the COVID-19 infection. The diagnosis of IE was crucially facilitated by transesophageal echocardiography.ConclusionsThis case highlights the potential association between COVID-19 and the development of infective endocarditis. Prompt evaluation using transesophageal echocardiography is vital when there is a high suspicion of IE in COVID-19 patients. Further research is required to elucidate the precise relationship between COVID-19 and IE.

Abstract 10249: Infective Endocarditis: A Diagnostic Challenge

Case: A healthy 30-year-old female with past medical history of eczema and no prior cardiac history presented with altered mental status, fever, neck stiffness and photophobia. Blood and CSF cultures grew methicillin susceptible Staphylococcus aureus , and the patient was started on nafcillin and linezolid. Bacteremia source was unclear, presumed to be minor skin breaks on her hands. MRI brain revealed multiple cerebral septic emboli, prompting concern for infective endocarditis. However, TTE and TEE were negative for vegetations, valve thickening, and valvular regurgitation. Blood cultures remained positive for MSSA despite dual antibiotic therapy and by hospital day 4, she began experiencing shortness of breath and new Janeway lesions were noted on exam. Repeat TTE and TEE were also negative for endocarditis. To further evaluate for an arterial source of seeding, CTA chest/abdomen was obtained which was unremarkable. Given persistence of bacteremia despite dual antibiotic therapy and unknown left-sided source, whole body PET CT scan was obtained which showed focal FDG uptake in the mitral annulus/valve region. Repeat TEE the following day showed a mitral valve ring abscess, a 1.2x0.4cm vegetation involving the P3 segment of the mitral valve, perforation at the mitral valve annulus, and new moderate mitral regurgitation. After a risk benefit discussion, the patient opted for conservative management with serial monitoring over surgical repair. She was treated with six weeks of nafcillin and four weeks of linezolid. Most recent TEE showed resolution of valvular abscess and vegetation with continued moderate mitral regurgitation. Discussion: We present a case of high grade MSSA endocarditis in a young, healthy patient without pre-existing valvular disease, causing mitral valve perforation. Infective endocarditis remains a challenging diagnosis, and this case highlights the diagnostic utility of FDG PET CT scan in such complex cases.

Mitral valve perforation after left lateral accessory pathway ablation: a case report

BackgroundRadiofrequency catheter ablation is considered to be a relatively safe procedure. This is an unusual case report in which severe mitral regurgitation was occurred after left lateral accessory pathway radiofrequency catheter ablation.Case presentationA 15-year-old man without structural heart disease was referred for ablation of a left lateral accessory pathway. He was a rugby player who had lived with Wolff–Parkinson–White syndrome since 2017. In 2017, two failed extensive radiofrequency catheter ablations of a left lateral accessory pathway had been performed in another center. In June 2018, he underwent a third radiofrequency catheter ablation of a left lateral accessory pathway using an anterograde transseptal approach with an early recurrence one month later. A successful fourth procedure was performed in August 2018 using a retrograde aortic approach. Three months later, the patient presented to the hospital with atypical chest pain and dyspnea on exertion. Transthoracic echocardiography revealed severe mitral regurgitation caused by a perforation of the posterior leaflet. Given the symptoms and the severity of the mitral valve regurgitation, the decision was taken to proceed with surgical intervention. Posterior mitral leaflet perforation was confirmed intraoperatively. The patient underwent video-assisted mitral valve repair via Minithoracotomy approach.ConclusionThis case demonstrates a very rare complication of Wolff–Parkinson–White radiofrequency ablation.

Osler’s Subacute Infective Endocarditis on Rheumatic Heart: A Complicated Clinical Case That Reflects Four (4) Major Public Health Issues in Sub-Saharan Africa

Endocarditis is an inflammation of the endocardium and its structures (valves), most often of infectious origin, described by William Osler in 1885. In the 21st century, infective endocarditis remains a reality in our countries. We report a complicated case of infective endocarditis (IE). This is a 53-year-old woman, obese and passive smoker who died on the 5th day of her hospitalization following an infective endocarditis (IE) with bacterial strains resistant to the usual antibiotics: daughter of acute lithiasic cholecystitis, mother of major mitral valve perforation, brain abscess, ischemic stroke and atrial fibrillation. All were responsible for septic shock and fatal coma. Surgical management of the infective endocarditis in the first hours of her admission could have improved her prognosis. To conclude, in addition to its interests and its clinical particularities, our present observation has highlighted major public health problems specific to our sub-Saharan African countries, namely: The problem of the double health burden, the problem of delays in seeking care, the problem of resistance to antibiotics and the problem of the insufficiency of reference health technical platforms.

Spontaneous mitral valve perforation associated with mitral annular calcification-related calcified amorphous tumor assessed by three-dimensional transesophageal echocardiography.

Spontaneous mitral valve perforation associated with mitral annular calcification-related calcified amorphous tumor assessed by three-dimensional transesophageal echocardiography.

A RARE CASE OF SPONTANEOUS MITRAL VALVE PERFORATION

Mitral valve perforation is a rare and potentially fatal heart condition that causes mitral regurgitation. The most common cause for mitral valve perforation is infective endocarditis, but connective tissue disease, trauma to the chest, cardiac surgery, and eccentric aortic regurgitation are other

A Calcified Amorphous Tumor Causing Mitral Valve Perforation and Ruptured Chordae Tendineae

A Calcified Amorphous Tumor Causing Mitral Valve Perforation and Ruptured Chordae Tendineae

Mitral valve perforation due to coexisting severe aortic regurgitation.

Mitral valve perforation due to coexisting severe aortic regurgitation.

Endocardite infectieuse mitro-aortique compliquée de perforation valvulaire, d’anévrisme mycotique et d’infarctus spléno-rénal

L'endocardite infectieuse est considérée comme une pathologie potentiellement grave malgré tous les progrès en diagnostic et traitement. Les valves du cœur gauche sont plus touchées et les évènements emboliques, les anévrismes mycotiques, les abcès ainsi que les perforations des valves en sont des complications redoutables. Nous rapportons le cas d'une endocardite ayant atteint les valves aortique et mitrale et qui s'est compliquée d'infarctus splénique et rénale, d'anévrisme mycotique cérébral et d'une perforation de la grande valve mitrale. L'intérêt du cas est souligné suite à la bonne évolution au décours d'un traitement médico-chirurgical en dépit de la multitude des complications.

Lyme Endocarditis

BackgroundValvular involvement as a manifestation of Lyme carditis is rare. The first case describing a possible association between Lyme disease and cardiac valvular disease in the United States was published in 1993. Since that time there have been 2 cases of Lyme endocarditis confirmed by Borrelia-positive 16S ribosomal RNA polymerase chain reaction and sequencing from valvular tissue and reported from Europe. Here we describe a case of Lyme endocarditis that, to our knowledge, is the first reported case confirmed by molecular diagnostics in the United States. MethodsWe present the case of a 68-year-old man with progressive dyspnea who had mitral valve perforation with severe mitral valve insufficiency seen on transesophageal echocardiogram. ResultsSubsequently resected valve tissue had signs of acute inflammation without organisms seen. Although blood and valve tissue cultures were negative, 16S ribosomal RNA polymerase chain reaction and sequencing demonstrated Borrelia burgdorferi. ConclusionLyme endocarditis can be a challenging diagnosis to confirm, given the rarity of cases and the need for molecular tools of resected valve tissue. It should be included among diagnostic possibilities in patients with culture-negative endocarditis who have exposure to ticks in endemic and emerging areas of Lyme disease.

A Rare Case of Atrial Myxoma Causing Mitral Valve Perforation in a Young School Leaver

A Rare Case of Atrial Myxoma Causing Mitral Valve Perforation in a Young School Leaver

COMPLICATIONS OF INFECTIVE ENDOCARDITIS: THE COMMON TO THE DEVASTATING

The initial diagnosis of infective endocarditis can be difficult and challenging to make. A delay in diagnosis can result in potentially life threatening outcomes. Care of the patient with endocarditis must include vigilant assessment for the development of signs and symptoms of embolization and other potential complications. A previously healthy 23-year old male presented to an urgent care centre with general malaise lasting two weeks. CBC, electrolytes, creatinine, chest x-ray, and blood cultures were drawn; the patient was sent home. When the blood cultures were reported positive for streptococcus mitis, the patient was redirected to emergency, and admitted for a full work up for endocarditis. An echocardiogram reported mitral valve (MV) vegetation, perforation, and severe MV regurgitation. Cardiac surgery was consulted and an urgent plan for MV repair or replacement was made. Surgery was delayed as the team was awaiting negative blood cultures. He remained in hospital to await surgery and was started on intravenous antibiotics. During this admission, the patient had complications that will be discussed. Infective endocarditis is a serious, potentially life threatening illness that requires a collaborative approach from the entire health care team. Nursing implications for infective endocarditis include cardiac monitoring for potential lethal arrhythmias, vigilant assessments for re-occurrence of infection, and signs and symptoms of heart failure or embolization.

Haemophilus parainfluenzae Endocarditis Associated With Maxillary Sinusitis and Complicated by Cerebral Emboli in a Young Man.

HACEK endocarditis is often difficult to diagnose given the slow-growing characteristics of the organisms involved. Haemophilus parainfluenzae, one of the HACEK organisms, is an uncommon cause of endocarditis. We describe a case of a previously healthy young man with H parainfluenzae endocarditis that was associated with maxillary sinusitis and severe systemic complications, including septic cerebral emboli and mitral valve perforation. Previously reported cases have also described a predilection for younger people, cardiac valve pathology, and a high prevalence of stroke.

Transseptal Anchored Vascular Plug Closure of Mitral Valve Perforation

A 15-year-old post-neonatal repair of truncus arteriosus sustained an anterior leaflet mitral valve injury during elective aortic root replacement and aortic valve repair, resulting in severe mitral regurgitation ([Figure 1][1], [Online Video 1][2]). He was deemed not to be a surgical candidate in

Mitral Valve Perforation in Libman–Sacks Endocarditis: A Heart-Wrenching Case of Lupus

Libman-Sacks (LS) endocarditis is one of the most common cardiac manifestations of systemic lupus erythematosus. Rarely, however, it can lead to serious complications, including severe valvular regurgitation or superimposed bacterial endocarditis. We describe the initial diagnostic challenges, clinical course, imaging studies and histopathological findings of a patient who presented with life-threatening lupus complicated by hemoptysis and respiratory failure secondary to a rare complication of LS endocarditis, acute mitral valve perforation. We review the current literature on valve perforation in the setting of LS endocarditis. In conclusion, although the disease is often asymptomatic and hemodynamically insignificant, it can result in serious and potentially fatal complications secondary to valve perforation, which may demand emergency surgical management.

Mitral Valve Perforation: The Value of Real Time Three-Dimensional Transesophageal Echocardiography

A 63-year-old man was referred to perform a transesophageal echocardiography (TEE) for suspicion of mitral endocarditis. The 2-Dimensional TEE showed a solution of continuity in the anterior leaflet of the mitral valve compatible with mitral perforation