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Echocardiographic abnormalities in acute rupture of the aortic valve due to infective endocarditis
Abstract:
The M-mode echocardiographic findings seen in 5 patients with acute rupture of the aortic valve leaflets due to infective endocarditis are described. These findings embrace a wide spectrum of abnormalities seen in the aortic root in diastole and they are (1) fine, high frequency oscillating echoes, (2) thick oscillating bands of echoes, and (3) dense shaggy echoes loosely attached to the aortic valve leaflets. Three patients showed persistence of these aortic root echoes right up to the level of the left ventricular outflow tract. All 5 patients demonstrated early closure of the mitral valve and exaggerated motion of the interventricular septum and the posterior wall of the left ventricle. Two patients died from the illness and the remaining 3 had successful aortic valve replacement after appropriate antibiotic therapy. The aortic valve and the aortic root were carefully examined in all 5 patients either at necropsy or at operation. Two patients had leaflet perforation alone, whereas the remaining 3 had both leaflet perforations as well as vegetations. An attempt was made to correlate morphologic findings with the echocardiographic abnormalities. It is concluded that it is frequently difficult from abnormal echoes in the aortic root alone to differentiate between ruptured leaflets and vegetations. However, the presence of the combination of early closure of the mitral valve, exaggerated motion of the interventricular septum and the posterior wall of the left ventricle, together with abnormal aortic root echoes as described above should strongly suggest acute rupture of the aortic valve leaflets due to infective endocarditis, or in rare cases myxomatous degeneration of the aortic valve.
Insights
M-mode echocardiography reveals specific aortic root echo abnormalities in patients with infective endocarditis. A combination of these echoes with mitral valve early closure and septal motion suggests acute aortic valve leaflet rupture.
Area of Science:
- Cardiology
- Medical Imaging
- Infectious Diseases
Background:
- Infective endocarditis can lead to severe complications affecting heart valves.
- Acute rupture of aortic valve leaflets presents diagnostic challenges.
- Echocardiography is crucial for evaluating cardiac structures and function.
Purpose of the Study:
- To describe M-mode echocardiographic findings in patients with acute aortic valve leaflet rupture due to infective endocarditis.
- To correlate echocardiographic abnormalities with morphological findings.
- To identify key echocardiographic indicators for diagnosing this condition.
Main Methods:
- Retrospective analysis of M-mode echocardiograms from 5 patients.
- Clinical examination, necropsy, or operative findings for morphological correlation.
- Detailed description of observed echocardiographic abnormalities in the aortic root and cardiac walls.
Main Results:
- Observed echocardiographic findings included fine, thick oscillating, and dense shaggy echoes in the aortic root.
- Persistence of aortic root echoes up to the left ventricular outflow tract was noted in some patients.
- Early mitral valve closure and exaggerated interventricular septum and posterior wall motion were consistent findings.
Conclusions:
- Differentiating between leaflet rupture and vegetations based solely on aortic root echoes can be difficult.
- A combination of specific aortic root echoes, early mitral valve closure, and altered septal/wall motion strongly suggests acute aortic valve leaflet rupture from infective endocarditis.
- Myxomatous degeneration of the aortic valve is a rare differential diagnosis.