Calcific embolization with infective endocarditis involving the posterior mitral leaflet in a patient with underlying...

Area of Science:

• Cardiology
• Infectious Diseases
• Cardiovascular Surgery

Background:

• Hypertrophic obstructive cardiomyopathy (HOCM) typically involves anterior mitral leaflet endocarditis in cases of infective endocarditis (IE).
• Recurrent outflow obstruction and valvular regurgitation in HOCM patients predispose to endocardial damage, primarily on the anterior mitral leaflet and basal septal myocardium.
• Infective endocarditis presents unique challenges in patients with complex cardiac conditions like HOCM.

Observation:

• A rare case of infective endocarditis involving the posterior mitral leaflet (PML) was observed in a patient with HOCM.
• The patient experienced calcific embolization, leading to repeated embolic strokes.
• Management was complicated by moderate mitral stenosis, dynamic left ventricular outflow tract obstruction, and flash pulmonary edema.

Findings:

• This is the first reported instance of posterior mitral leaflet (PML) involvement in infective endocarditis (IE) within the context of hypertrophic obstructive cardiomyopathy (HOCM).
• Calcific embolization from the infected PML resulted in significant neurological complications.
• The co-occurrence of mitral stenosis, dynamic left ventricular outflow tract obstruction, and pulmonary edema complicated the clinical course.

Implications:

• This case expands the understanding of potential IE manifestations in HOCM, particularly concerning posterior mitral leaflet involvement.
• Recognizing this rare presentation is crucial for timely diagnosis and appropriate management strategies in HOCM patients with IE.
• Further research may elucidate the specific mechanisms leading to PML endocarditis in HOCM and inform treatment protocols.