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Pulmonic regurgitation due to valvular tophi
Circulation
|March 1, 1983
Summary
Cardiac tophi, deposits of urate crystals in the heart, are rare. This case highlights cardiac tophi causing valvular disease in a patient with congenital heart disease and gout.
Area of Science:
- Cardiology
- Rheumatology
- Pathology
Background:
- Cardiac tophi are rarely documented and have not been previously associated with clinically apparent valvular disease.
- Gout is a metabolic disorder characterized by hyperuricemia and deposition of monosodium urate crystals.
Observation:
- A 31-year-old male with complex cyanotic congenital heart disease (Taussig-Bing anomaly) and secondary tophaceous gouty arthritis presented with a brain abscess and a new semilunar regurgitant murmur.
- Echocardiography initially suggested infective endocarditis due to suspected vegetative lesions causing the murmur.
Findings:
- Autopsy revealed sterile tophi, not infective endocarditis, as the cause of the semilunar regurgitant murmur.
- The tophi were located along the pulmonary valve's coaptation line, and additional tophaceous deposits were found in the mitral valve.
Implications:
- This case demonstrates that cardiac tophi can cause significant valvular dysfunction, specifically semilunar regurgitation.
- It underscores the importance of considering tophaceous disease in the differential diagnosis of valvular abnormalities, even in the presence of suspected infective endocarditis.