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Perforated aneurysms of left side valves during active infective endocarditis complicating hypertrophic obstructive
S de Castro1, R Adorisio, A Pelliccia
1Department of Cardiovascular and Respiratory Sciences, La Sapienza University, Rome, Italy. stefano.decastro@uniroma1.it
Insights
In patients with hypertrophic cardiomyopathy, severe valve damage from infective endocarditis can lead to poor outcomes. Echocardiography is crucial for diagnosis and guiding treatment of these complex cardiac conditions.
Area of Science:
- Cardiology
- Infectious Diseases
- Echocardiography
Background:
- Hypertrophic cardiomyopathy (HCM) frequently involves anterior mitral leaflet lesions due to systolic anterior motion.
- Infective endocarditis (IE) is a serious complication that can affect cardiac valves.
Observation:
- This study details three cases of severe IE with complicated lesions (vegetation, aneurysm, perforation) on aortic and mitral valves in patients with obstructive HCM.
- Particular hemodynamic conditions and severe valvular damage were observed in these patients.
Findings:
- Severe valvular damage and dysfunction in HCM patients with IE are associated with adverse clinical outcomes.
- Transthoracic echocardiogram and transesophageal echocardiography were used to define the morphologic and hemodynamic features of the infection.
Implications:
- Understanding these complex interactions is vital for appropriate therapeutic strategies in HCM patients with IE.
- Echocardiographic follow-up is essential for managing these challenging cases and improving patient prognosis.
Abstract:
The most frequent site of vegetative lesion in patients with hypertrophic cardiomyopathy is anterior mitral leaflet, due to chronic endocardial trauma arising from systolic anterior motion. We describe three cases of serious infective endocarditis complicated lesions (vegetation, aneurysm and perforation) on aortic and mitral valves, in patients with obstructive hypertrophic cardiomyopathy. In particular, we observed how severe valvular damage and dysfunction, combined with particular hemodynamic conditions, are followed by adverse clinical outcome. We performed transthoracic echocardiogram and transoesophageal echocardiography studies to define morphologic and hemodynamic features of infection, deciding the proper therapy and we planned the echocardiographic follow-up.