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[A case of perforated mitral valve aneurysm following aortic valve replacement associated with infective
J Takahashi1, M Shimizu, K Morimoto
1Department of Cardiovascular Surgery, Aishin Memorial Hospital, Sapporo, Japan.
Abstract:
A case of perforated mitral valve aneurysm following aortic valve replacement associated with infective endocarditis was reported. The patient was a 29-year-old man, who was suffering from high fever, Osler's nodules and headache. A brain abscess was recognized in a computed tomography and 3rd grade aortic regurgitation was recognized in echocardiogram and aortography. Hematological studies suggested the inflammation and gram-positive cocci was incubated from his arterial blood. Then infective endocarditis with aortic regurgitation was diagnosed. AVR was performed following 8 weeks treatment with antibiotics, when he had negative CRP and his blood culture. After the operation, he was received the intravenous antibiotic therapy for 6 weeks and oral antibiotic drugs was given following his hospital discharge. At 6 months after AVR, mitral valve aneurysm was recognized in his echocardiogram. At 30 months after AVR, the perforation of it was revealed and mitral valve replacement was performed with his negative blood culture. The patient was discharged 28th day after MVR. There has been no active inflammation from his first hospital discharge and following days, the mitral valve aneurysm and the perforation was caused by weakened tissue of the anterior mitral leaflet due to sibilant inflammatory change.
Insights
A perforated mitral valve aneurysm developed six months after aortic valve replacement in a young man with infective endocarditis. This rare complication required a subsequent mitral valve replacement.
Area of Science:
- Cardiology
- Infectious Diseases
- Cardiac Surgery
Background:
- Infective endocarditis (IE) is a serious infection that can affect heart valves.
- Aortic valve replacement (AVR) is a common surgical procedure for severe aortic valve disease.
- Complications following AVR, though rare, require careful monitoring and management.
Observation:
- A 29-year-old man presented with symptoms of IE, including fever and Osler's nodules.
- He underwent AVR for severe aortic regurgitation secondary to IE.
- Six months post-AVR, a mitral valve aneurysm was detected, which perforated 30 months later.
Findings:
- The mitral valve aneurysm and subsequent perforation were attributed to tissue weakening from persistent inflammatory changes.
- The patient successfully underwent mitral valve replacement (MVR) after the aneurysm perforation.
- No active inflammation was noted after the MVR, indicating successful treatment.
Implications:
- This case highlights a rare but significant delayed complication of IE and AVR.
- It underscores the importance of long-term echocardiographic surveillance after valve surgery in patients with a history of IE.
- Understanding the pathophysiology of post-inflammatory valve damage is crucial for preventing such complications.