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[Perforation of the mitral valve: transesophageal echocardiographic diagnosis in 3 cases]
J C Yáñez Wonenburger1, M A García-Fernández, D San Román Sánchez
1Departamento de Cardiología, Hospital General Gregorio Marañon, Madrid.
Abstract:
We submit 3 cases of perforation of the mitral valve leaflet as a consequence of infectious endocarditis. In the first of this cases, perforation was the result of the impact of the regurgitant jet of an aortic insufficiency affected by bacterial endocarditis of the anterior mitral leaflet in a young female presenting various congenital malformations. Both the transthoracic and transesophageal echocardiography showed that the regurgitant jet affected the area where the lesions were later detected. In the other 2 cases the perforation appeared in valves previously affected by endocarditis. In these cases, only the transesophageal echocardiography showed the lesions. Surgery was performed in all 3 cases with satisfactory results, confirming the echocardiographical findings. We wish to emphasize the role of transesophageal echocardiography in the diagnosis of this rare process that may be the primary effect of the destructive action of the endocarditis, or a secondary effect, on dissemination by means of affected valves, on previously unaffected valvular leaflets.
Insights
Infectious endocarditis can cause mitral valve leaflet perforation, sometimes due to aortic insufficiency regurgitant jets. Transesophageal echocardiography is crucial for diagnosing this rare condition, whether primary or secondary to endocarditis.
Area of Science:
- Cardiology
- Infectious Diseases
- Cardiac Surgery
Background:
- Infectious endocarditis is a serious infection affecting heart valves.
- Mitral valve leaflet perforation is a rare but significant complication.
Observation:
- Three cases of mitral valve leaflet perforation secondary to infectious endocarditis are presented.
- The first case involved perforation from a regurgitant jet of aortic insufficiency in a patient with congenital malformations.
- The other two cases showed perforation in previously endocarditis-affected valves.
Findings:
- Transthoracic and transesophageal echocardiography were used for diagnosis.
- Transesophageal echocardiography was particularly effective in identifying lesions in all cases.
- Surgical intervention in all three cases yielded satisfactory outcomes, confirming echocardiographic findings.
Implications:
- Transesophageal echocardiography plays a vital role in diagnosing mitral valve perforation in infectious endocarditis.
- Perforation can be a direct result of endocarditis or a secondary consequence of valve damage and spread.
- Early and accurate diagnosis is essential for timely surgical management and improved patient outcomes.