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Published on: May 19, 2020
Mitral Valve Aneurysm With Severe Mitral Regurgitation and Pseudoaneurysm Formation: A Rare Complication of Infective
Kesar Prajapati1, Fnu Samaksh1, Poornima Jaiswal Charpuria1
1Internal Medicine, New York Medical College, Metropolitan Hospital Center, New York, USA.
Abstract:
Infective endocarditis (IE) is a life-threatening condition caused by infection of the heart's endocardial surface, often involving native or prosthetic valves. It presents with diverse symptoms, ranging from isolated fever and heart failure to more severe manifestations such as ischemic stroke from septic or thrombus embolization. A rare but serious complication of IE is mitral valve aneurysm (MVA), a localized outpouching of the mitral valve, often leading to mitral regurgitation (MR), heart failure, and, in severe cases, rupture. This report highlights a case of delayed diagnosis of IE in a 34-year-old female who presented with prolonged fever, progressive dyspnea, and signs of heart failure. Echocardiography revealed severe MR, anterior mitral valve leaflet perforation, and a large pseudoaneurysm, suggesting MVA. Because of the advanced presentation, the patient developed refractory heart failure and electrical storm, leading to a fatal outcome before surgery could be performed. This case underscores the importance of early recognition of IE and MVA and the challenges in managing complicated cases, where mitral valve replacement is the preferred surgical option. Early diagnosis and timely intervention are crucial to prevent severe complications and improve prognosis.
Insights
Infective endocarditis (IE) can lead to mitral valve aneurysm (MVA), a dangerous complication. Early diagnosis and treatment are vital for preventing severe outcomes like heart failure and stroke.
Area of Science:
- Cardiology
- Infectious Diseases
- Cardiac Surgery
Background:
- Infective endocarditis (IE) is a serious infection of the heart's inner lining, frequently affecting heart valves.
- Mitral valve aneurysm (MVA) is a rare but severe complication of IE, potentially causing mitral regurgitation and heart failure.
Observation:
- A 34-year-old female presented with prolonged fever, dyspnea, and heart failure symptoms, indicative of delayed IE diagnosis.
- Echocardiography revealed severe mitral regurgitation, mitral valve leaflet perforation, and a pseudoaneurysm, suggesting MVA.
Findings:
- The patient experienced refractory heart failure and electrical storm due to the advanced stage of IE and MVA.
- Despite the critical condition, the patient's outcome was fatal before surgical intervention could be performed.
Implications:
- This case emphasizes the critical need for prompt recognition and management of infective endocarditis and mitral valve aneurysm.
- Early diagnosis and timely intervention, potentially including mitral valve replacement, are essential for improving patient prognosis and preventing fatal complications.
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