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Posterior Mitral Leaflet (PML) Perforation due to Infective Endocarditis (IE) Complicated with Cerebral Infarction

Hideki Sasaki1, Yukihide Numata1, Jien Saito1

  • 1Cardiovascular Surgery, Nagoya City University East Medical Center, Nagoya, JPN.

Cureus
|April 24, 2023
PubMed

Insights

A 64-year-old man with endocarditis experienced a stroke due to a mitral valve vegetation embolism. Successful mitral valve repair using autologous pericardium restored function.

Area of Science:

  • Cardiovascular Medicine
  • Infectious Diseases
  • Neurosurgery

Background:

  • Infective endocarditis can lead to embolic complications, particularly in patients with pre-existing conditions like kidney disease requiring dialysis.
  • Mitral valve vegetation poses a significant risk for systemic embolism, potentially causing cerebrovascular events.
  • Early diagnosis and intervention are crucial for managing infective endocarditis and its sequelae.

Observation:

  • A 64-year-old male on dialysis presented with fever and chills, found to have a posterior mitral leaflet vegetation on transthoracic echocardiography.
  • The patient developed right hemiparesis, with brain MRI revealing a left middle cerebral artery occlusion, indicative of embolism.
  • Transesophageal echocardiography demonstrated posterior mitral leaflet perforation and severe mitral regurgitation.

Findings:

  • The patient underwent successful mitral valve repair using fresh autologous pericardium.
  • Postoperative recovery was uneventful, with discharge following six weeks of antibiotic therapy.
  • Autologous pericardium is identified as a suitable material for mitral valve repair in such cases.

Implications:

  • This case highlights the critical link between infective endocarditis, valvular damage, and embolic stroke.
  • Timely surgical intervention for mitral valve pathology secondary to endocarditis can prevent further neurological damage.
  • The use of autologous pericardium offers a viable reconstructive option for mitral valve repair, emphasizing the importance of material choice in complex cardiac surgeries.
Keywords:
autologous pericardiumbrain infarctioninfective endocarditismitral valve perforationmitral valve regurgitation

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