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[A case of infective mitral endocarditis after percutaneous transvenous mitral commissurotomy]
1Department of Cardiovascular Surgery, Kinan General Hospital, Wakayama, Japan.
Abstract:
We encountered a case of infective mitral endocarditis (IE) due to Methicillin resistant staphylococcus aureus (MRSA) after percutaneous transvenous mitral commissurotomy (PTMC). A 65-year-old woman underwent PTMC for mitral stenosis. Two days later, she incurred a fever of more than 40 degrees C, and MRSA was detected in her blood culture. Inflammation and renal function deteriorated despite transvenous administration of antibiotics. Transesophageal echocardiogram revealed vegetation at the mitral valve. Mitral valve replacement was performed after diagnosis of IE, and MRSA was identified from the vegetation. The patient improved with the transvenous application of antibiotics including vancomycin hydrochloride. The blood culture became negative and inflammation was suppressed. In view of this case, we consider that IE is a possible complication following PTMC.
Insights
Infective endocarditis caused by MRSA can occur after percutaneous transvenous mitral commissurotomy. Prompt diagnosis and treatment, including valve replacement and antibiotics, are crucial for patient recovery.
Area of Science:
- Cardiology
- Infectious Diseases
- Cardiac Surgery
Background:
- Percutaneous transvenous mitral commissurotomy (PTMC) is a procedure to treat mitral stenosis.
- Infective endocarditis (IE) is a serious infection of the heart valves.
Observation:
- A 65-year-old woman developed severe fever and MRSA bacteremia two days post-PTMC.
- Transesophageal echocardiogram revealed mitral valve vegetation.
- Renal function deteriorated despite initial antibiotic therapy.
Findings:
- Methicillin-resistant Staphylococcus aureus (MRSA) was identified as the causative agent from blood cultures and valve vegetation.
- Mitral valve replacement was necessary for definitive treatment.
- The patient improved with vancomycin hydrochloride and antibiotics, with negative blood cultures and suppressed inflammation.
Implications:
- IE is a potential complication following PTMC procedures.
- Early recognition and aggressive management are vital for patients presenting with post-PTMC fever and bacteremia.
- This case highlights the importance of considering MRSA in post-procedural infections.