The successful surgical repair of a left ventricular-right atrial communication and aneurysm of the mitral valve caused by infective endocarditis: Report of a case

Surgery Today ◽  
1994 ◽  
Vol 24 (7) ◽  
pp. 655-658 ◽  
Author(s):  
Yoshikatsu Saiki ◽  
Mitsuhiko Kawase ◽  
Takao Ida ◽  
Eiichi Mannouji ◽  
Hitoshi Kasegawa ◽  
...  
Keyword(s):  
Infective Endocarditis ◽  
Mitral Valve ◽  
Surgical Repair ◽  
Left Ventricular ◽  
Right Atrial

scholarly journals P1694 Prosthetic mitral valve infective endocarditis complicated by left ventricle to right atrial fistula

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
R M Abayazeed ◽  
H Shehata ◽  
O Elgebaly ◽  
M A Abdel-Aziz ◽  
M A Abdel-Hay
Keyword(s):  
Infective Endocarditis ◽  
Mitral Valve ◽  
Left Ventricle ◽  
Valve Replacement ◽  
Mitral Valve Replacement ◽  
Tricuspid Valve ◽  
Left Ventricular ◽  
Right Atrial ◽  
History Of ◽  
Prosthetic Mitral Valve

Abstract Left ventricle (LV) to right atrial (RA) shunt is a rare type of ventricular septal defect. Acquired LV-RA shunt is rare and may occur as complication of cardiac surgery, endocarditis, thoracic trauma or myocardial infarction. Infective endocarditis is the second most important cause of this type of shunt. Case presentation A 44 year old female patient presented to our hospital complaining of progressive exertional dyspnea and palpitations for 6 months, and high grade fever for 2 weeks. The patient had history of mitral valve replacement with mechanical prosthesis 16 years ago. The patient had no history of recent invasive procedures or dental interventions. General examination revealed an irregular pulse at rate of 100 beats per minute (bpm), blood pressure of 100/60 mmHg, temperature of 38.5 ͦ C and congested neck veins. Cardiac examination revealed an audible prosthetic mitral click with a harsh pansystolic murmur heard on the apex and left sternal border, and an accentuated P2 over the pulmonary area. Her resting electrocardiogram (ECG) showed atrial fibrillation with ventricular response of 110 bpm. Her laboratory investigations revealed normochromic normocytic anemia with Hemoglobin level of 8 g/dl (13-16), and leucocytosis with white blood cell count of 16.24 103 cell/ ul (4.00-11.00); as well as elevated C-reactive protein (CRP) level of 73 (0-3). Her international normalized ratio (INR) was 3 (1-1.3) on warfarin 5 mg. Transthoracic echocardiography (TTE) revealed a dehiscent prosthetic mitral valve with severe paravalvular regurgitation, severe tricuspid valve regurgitation and pulmonary hypertension with predicted resting pulmonary artery systolic pressure of 60 mmHg. It also showed an abnormal jet passing from the LV into the RA above the tricuspid valve during systole, both right and left ventricular systolic functions were preserved. Subsequent 2D/3D transoesophageal echocardiography (TEE) confirmed the TTE findings with detection of LV-RA fistula with significant left to right shunt; it also visualized multiple vegetations attached to the mitral annulus at the site of the valve dehiscence. The patient was diagnosed with prosthetic mitral valve infective endocarditis, empirical antibiotics were started and the patient was referred for another center for urgent surgery. Redo mitral valve replacement, tricuspid valve repair and closure of the defect were done; the patient developed complete heart block postoperatively and permanent pacemaker was inserted. Conclusion Infective endocarditis remains a major health problem with high mortality and severe complications. It is important to keep high index of suspicion in high risk patients for infective endocarditis as delayed diagnosis increases the risk of serious complications and mortality, and makes surgical intervention, if indicated, more demanding with increased incidence of perioperative complications. Abstract P1694 Figure. TTE&TEE of prosthetic mitral IE

Abstract 17266: Right Atrial Volumes Changes in Tetralogy of Fallot

Circulation ◽  
2018 ◽  
Vol 138 (Suppl_1) ◽  
Author(s):  
Ashish Patel ◽  
Divya Shakti ◽  
Chad Blackshear
Keyword(s):  
Diastolic Dysfunction ◽  
Diastolic Function ◽  
Tetralogy Of Fallot ◽  
Surgical Repair ◽  
Left Ventricular ◽  
Right Atrial ◽  
Before And After ◽  
Ventricular Diastolic Dysfunction ◽  
And Function ◽  
Averaged Model

Introduction & Hypothesis: There is limited information on right atrial (RA) function in the congenital heart defects. RA volume and function may give insight into the right ventricle (RV) diastolic function. We sought to assess RA function in tetralogy of Fallot (TOF) patients prior to and after complete surgical repair. Methods: Infants with TOF prior to complete repair were included for retrospective chart review and offline analysis of 2-dimensional echocardiograms (echo) before and after surgical repair. RA phasic volumes and stroke volumes were calculated. All volumes were indexed to body surface area. Results: There were 40 infants with TOF (45% females), of which 70% had pulmonary stenosis, 30% pulmonary atresia. Roughly 85% and 60% had 3, or more, echo available pre- and postoperatively. Table 1 (attached) shows the patient characteristics and phasic RA volumes. The indexed RA phasic volumes were in normal range in initial echo prior to surgery. We used normal index RA phasic volumes published by European Society of Echocardiography. There was the increasing trend of indexed RA phasic volume on follow up echo immediately before TOF repair. These phasic volumes continued to remain elevated after complete surgical repair (Table 1). Trends in RA stroke volumes for all available echos before and after surgery were modeled using a population-averaged model with an exchangeable within-panel correlation structure (Figure 2), showing no statistically significant difference after surgery. But there was statistical significance noted in RA ejection fraction. Please see attached image for statistical analysis and results of the study. Conclusions: The indexed RA phasic volumes in children with TOF are normal initially and increases before TOF repair and it continued to increase after TOF repair. The increase RA phasic volumes suggest RV diastolic dysfunction similar to the findings of LA phasic volumes and left ventricular diastolic dysfunction. Our findings indicate slow worsening RV diastolic function in patients with TOF after surgical repair. RA volume and function can be the novel marker to diagnose and monitor right ventricular diastolic dysfunction.

Acquired left ventricular-right atrial and right ventricular communication due to infective endocarditis after aortic valve replacement

1990 ◽  
Vol 120 (5) ◽  
pp. 1233-1234 ◽  
Author(s):  
Josef Kautzner ◽  
Miroslav J. Munclinger ◽  
Michaela Kozáková
Keyword(s):  
Infective Endocarditis ◽  
Aortic Valve ◽  
Aortic Valve Replacement ◽  
Right Ventricular ◽  
Valve Replacement ◽  
Left Ventricular ◽  
Right Atrial

scholarly journals P228 Mitral valve aneurysm in the context of post-infective endocarditis in hypertrophic cardiomyopathy: an issue of inflammation or pressure gradients?

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
I Pereira Oliveira ◽  
D Seabra ◽  
A Neto ◽  
I Cruz ◽  
G Abreu ◽  
...  
Keyword(s):  
Case Report ◽  
Infective Endocarditis ◽  
Hypertrophic Cardiomyopathy ◽  
Mitral Valve ◽  
Late Complication ◽  
Fatal Outcome ◽  
Left Ventricular ◽  
Pressure Gradients ◽  
Optimal Approach

Abstract Mitral valve aneurysms (MVA) are uncommon and usually develop acutely in the setting of infective endocarditis (IE). We present a case report of a patient with a ruptured aneurysm of the mitral valve (MV) leaflet and obstructive hypertrophic cardiomyopathy (HCM), previously treated for IE. Echocardiography is essential for diagnosis, highlighting the importance of imaging for early identification and timely intervention. CASE REPORT 68-year-old male patient with type 2 diabetes mellitus and dyslipidemia was admitted to hospital with a 3-week history of malaise, fever and recent left-sided abdominal pain. No past relevant history. Physical examination revealed a grade II/VI systolic heart murmur at the cardiac apex, fever, abdominal tenderness in the left upper quadrant and purpuric lesions in the inferior limbs. Neutrophilia, CPR 211mg/L. Positive blood cultures for Staphylococcus aureus methicillin-sensitive. Spleen embolization, with no abcess on abdominal CT. Transthoracic (TTE) and transesophageal echocardiography (TEE) disclosed a highly mobile polypoid mass in the atrial side of the anterior MV leaflet, septal left ventricular hypertrophy and systolic anterior motion (SAM) of the MV. Mild mitral regurgitation (MR). No evidence of abcess, aneurysm or valve perforation. The diagnosis of IE was established and the patient completed 42 days of Flucloxaciline. Favorable clinical evolution, residual lesions on the MV. TTE and TEE were repeated on follow-up. Besides HCM and SAM of the MV, an aneurysm of the anterior leaflet of the MV was identified and two regurgitant jets: one due to incomplete coaptation of the leaflets; other through the perforated aneurysm. Mild global MR. A strategy of close follow-up was adopted. Beta blocker dose was increased. Maintenance of the characteristics of the aneurysm. DISCUSSION MVA are rare, with perforation and significant MR development as the most serious complications. They mostly develop in the acute setting of IE of the aortic valve (AV), due to the "jet lesion" from the regurgitant jet or direct extension of the infection. In this case, MVA developed as a late complication of IE of the MV. Previous infection and inflammation lead to increased susceptibility of the valve leaflet, with possible persistent chronic inflammation. In the setting of obstructive HCM, the lesioned endothelium is exposed to significant intraventricular pressure gradients, which have probably raised its propensity to bulge towards the atrium, resulting in aneurysm formation and perforation. Optimal approach to MVA has not been defined. If the setting of perforation with severe MR, surgery must be performed in order to avoid a fatal outcome. In small aneurysms with mild MR, a conservative approach seems reasonable. The purpose of this case is to highlight potential complications of IE, which should be actively investigated, with echocardiography playing a central role in the diagnosis and follow-up.

P-130 Left Ventricular Perivalvular Pseudoaneurysm After Infective Endocarditis of the Mitral Valve

2009 ◽  
Vol 4 ◽  
pp. S88
Author(s):  
Pavol Chnupa ◽  
Juraj Dubrava ◽  
Iveta Simkova
Keyword(s):  
Infective Endocarditis ◽  
Mitral Valve ◽  
Left Ventricular

Acquired Left Ventricular-Right Atrial Communication and Severe Aortic Valve Regurgitation Caused by Infective Endocarditis

2009 ◽  
Vol 57 (01) ◽  
pp. 54-56 ◽  
Author(s):  
H. Inoue ◽  
Y. Iguro ◽  
T. Kinjo ◽  
H. Matsumoto ◽  
G. Yotsumoto ◽  
...  
Keyword(s):  
Infective Endocarditis ◽  
Aortic Valve ◽  
Left Ventricular ◽  
Right Atrial ◽  
Valve Regurgitation ◽  
Aortic Valve Regurgitation

scholarly journals A Left Ventricular Pseudoaneurysm Related to Infective Endocarditis in the Mitral Valve

2014 ◽  
Vol 43 (1) ◽  
pp. 15-18 ◽  
Author(s):  
Yusuke Takei ◽  
Ikuko Shibasaki ◽  
Riha Shimizu ◽  
Go Tsuchiya ◽  
Takayuki Hori ◽  
...  
Keyword(s):  
Infective Endocarditis ◽  
Mitral Valve ◽  
Left Ventricular ◽  
Left Ventricular Pseudoaneurysm

scholarly journals Left ventricular-right atrial communication caused by infective endocarditis: a peculiar presentation

2016 ◽  
Vol 37 (27) ◽  
pp. 2202-2202
Author(s):  
M.D. Gilbers ◽  
W.W.L. Li ◽  
A.P.J. van Dijk ◽  
W.J. Morshuis
Keyword(s):  
Infective Endocarditis ◽  
Left Ventricular ◽  
Right Atrial
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