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A Spiral in the Heart: Mitral Valve Endocarditis with Unusual Vegetation Shape Potentially Affecting Effectiveness of
Veronica Fibbi1, Piercarlo Ballo1, Alessandro Abbondanti1
1Cardiology Unit, S. Maria Annunziata Hospital, 50012 Florence, Italy.
Abstract:
We report an unusual case of infective endocarditis (IE) in an 88-year-old woman, occurring on a prolapsing mitral valve and characterized by an atypical vegetation shape resembling a spiral-like appearance. After the patient refused surgical correction, persistent IE despite prolonged antibiotic therapy was observed, resulting in an ischemic stroke probably secondary to septic embolus. The importance of vegetation shape in the management of patients with IE was classically related to the increased risk of embolization associated with pedunculated, irregular, and multilobed masses. We hypothesize that the unusual spiral-like vegetation shape in our patient may have favored IE persistence by two mechanisms, namely, a decrease of the exposed vegetation surface with creation of an internal core where the penetration of antimicrobial agents was obstacled and the creation of blood turbulence within the vegetation preventing a prolonged contact with circulating antibiotics. These considerations suggest that vegetation shape might be considered of importance in patients with IE not only because of its classical association with embolization risk, but also because of its potential effect on the efficacy of antibiotic therapy.
Insights
An unusual spiral-like vegetation shape in infective endocarditis (IE) may hinder antibiotic effectiveness and prolong infection. This case highlights the importance of vegetation morphology beyond embolization risk in managing IE patients.
Area of Science:
- Cardiology
- Infectious Diseases
- Medical Case Reports
Background:
- Infective endocarditis (IE) typically involves bacterial infection of heart valves.
- Vegetation morphology is classically linked to embolization risk in IE.
- Atypical vegetation shapes may influence treatment outcomes.
Purpose of the Study:
- To report a unique case of IE with spiral-like vegetations on a mitral valve.
- To explore the potential impact of this unusual vegetation shape on IE persistence and antibiotic efficacy.
- To consider vegetation morphology as a factor in IE management.
Main Methods:
- Case report of an 88-year-old female patient with IE.
- Clinical observation of persistent IE despite prolonged antibiotic therapy.
- Analysis of vegetation characteristics and hypothesized mechanisms of treatment resistance.
Main Results:
- The patient presented with IE on a prolapsing mitral valve with spiral-like vegetations.
- Persistent IE and an ischemic stroke occurred despite extensive antibiotic treatment.
- Hypothesized that the spiral shape impeded antibiotic penetration and prolonged contact.
Conclusions:
- Unusual vegetation shapes in IE may present unique challenges to antibiotic therapy.
- The spiral-like morphology might create an shielded core and disrupt antibiotic circulation.
- Vegetation shape should be considered in IE management, influencing both embolization risk and treatment efficacy.
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