Penetrating mitral valve annular abscess

We report a rare case of occult myocardial abscess due to group B Streptococcus that arose several weeks following streptococcal pneumonia. Hemopericardium was the initial presentation. Visualization of the abscess cavity was not possible with transthoracic echocardiography. A definitive diagnosis was made by left ventricular imaging during coronary arteriography. Rupture of the left ventricular free wall occurred during induction of anesthesia for operative exploration and debridement. Patch repair of the left ventricle was ultimately unsuccessful. Post-mortem examination revealed staphylococcal endocarditis of the mitral valve, valve ring abscess and multiple abscess cavities of the left ventricular free wall. A review of the clinical, diagnostic and therapeutic aspects of myocardial abscess is also presented.