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Published on: May 19, 2020
Infective endocarditis with perforation of the anterior mitral valve leaflet due to mild aortic regurgitation: a case
Tetsuo Yamanaka1, Michiaki Higashitani1, Yoshimaro Ichinohe1
1Department of Cardiology, Tokyo Teishin Hospital, 2-14-23 Fujimi, Chiyoda-ku, Tokyo 102-8798, Japan.
Background:
It has been reported that mechanical damage occurs when regurgitant flow from aortic regurgitation (AR) directly impinges on the anterior mitral valve leaflet (AML). However, only a few cases of mitral valve perforation have been reported. Previous reports suggest that AR in such cases tends to be Grade 3 or higher and that haemodynamic damage to the mitral valve due to AR may be proportional to its severity. On the contrary, no cases of mitral valve perforation due to mild AR have been reported.
Case Summary:
In 2011, a 56-year-old man presented with mild AR towards the AML, revealed on a transthoracic echocardiogram. In 2016, 3 months before admission, the patient had been experiencing intermittent fevers of over 40°C, which did not improve, and was referred to our hospital. A detailed examination revealed a vegetation on the AML where the aortic valve was displaced, and the site was perforated. The AR was mild to moderate. Blood cultures were positive for Streptococcus oralis. From these results, a definitive diagnosis of infective endocarditis (IE) was made. The patient had cerebral infarction and underwent semi-emergency surgery.
Discussion:
This case indicates that even mild AR directed at the AML can damage the AML, raising IE risk. Consequently, mild AR deviation towards the AML should be considered a potential risk factor for AML IE.
Insights
Mild aortic regurgitation (AR) directed at the anterior mitral valve leaflet (AML) can cause perforation and increase infective endocarditis (IE) risk. This case highlights that even mild AR poses a risk for AML IE.
Area of Science:
- Cardiology
- Infectious Diseases
- Valvular Heart Disease
Background:
- Mechanical damage to the anterior mitral valve leaflet (AML) is linked to aortic regurgitation (AR).
- Mitral valve perforation is rare, typically associated with severe AR (Grade 3+).
- No cases of mitral valve perforation due to mild AR have been previously reported.
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