Cardiac Tamponade following Mitral Valve Replacement for Active Infective Endocarditis with Ring Abscess

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R Ranjan1, T Lawrence1

  • 1Department of Cardiology, Cardiovascular and Thoracic Institute, University of Southern California, Los Angeles, CA 90033, USA.

Case Reports in Cardiology
|February 18, 2015
PubMed

Insights

Infective endocarditis (IE) with periannular extension requires complex surgery. This case shows a patient needing redo mitral valve replacement due to a recurrent abscess after initial treatment for IE.

Area of Science:

  • Cardiology
  • Infectious Diseases
  • Cardiac Surgery

Background:

  • Periannular extension and abscess formation are severe, high-mortality complications of infective endocarditis (IE).
  • Accurate disease extent definition requires multimodality cardiac imaging.
  • Surgical intervention, including debridement and valve replacement, is the primary treatment.

Purpose of the Study:

  • To present a case of recurrent periannular abscess after initial treatment for infective endocarditis.
  • To highlight the diagnostic findings and management of a complex IE complication.
  • To emphasize the importance of close perioperative follow-up and advanced imaging.

Main Methods:

  • Case report of a 29-year-old intravenous drug user with severe IE.
  • Initial surgical management: debridement, annular reconstruction, and mitral valve replacement (MVR).
  • Diagnosis of recurrence using transthoracic echocardiogram (TTE) revealing a large cavity and fistulous opening.
  • Second surgical intervention: redo MVR with patch closure of the fistulous tract.

Main Results:

  • The patient initially underwent successful debridement, reconstruction, and MVR.
  • Recurrence of symptoms (shortness of breath, pedal edema) occurred postoperatively.
  • TTE identified a large periannular cavity communicating with the left ventricle via a fistula.
  • Redo MVR with patch closure resulted in a good clinical outcome.

Conclusions:

  • Periannular extension of IE can recur even after initial surgical treatment.
  • Transthoracic echocardiogram is crucial for identifying classic findings of recurrent abscess and fistulous tracts.
  • Close perioperative monitoring and consideration of cardiac MRI for surgical planning are essential in managing complex IE cases.

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