Clinical and health care cost consequences of infective endocarditis in mitral valve prolapse

Abstract Funding Acknowledgements n/a Background Health care associated infective endocarditis (HAIE) accounted for u to 30% of infective endocarditis (IE) cases, it tends to affect patients with a poor clinical condition and represents a considerable in-hospital mortality. Case A 75-years old gentleman with end-stage renal failure secondary to polycystic kidney disease had commenced hemodialysis via a tunneled hemodialysis catheter 3 months ago, presented for pre-operative evaluation before vascular surgery for acute left lower limb ischemia, patient gave history of fever for the past month partially responding to antipyretics along with recent ischemic cerebrovascular stroke with no residual neurological deficits. On examination he had a blood pressure of 110/70 mmHg, a heart rate of 100 bpm, a temperature of 38oC, and a harsh pansystolic murmur over the apex. Laboratory results revealed leukocytosis elevated CRP and blood cultures were positive for staphylococcus aureus. Electrocardiography showed sinus tachycardia. Methods and Results 2D-Trans-Thoracic Echocardiography (TTE) revealed the presence of echogenic rounded mobile mass measured 2x2 cm attached to the atrial surface of the posterior mitral valve leaflet. There was a severe mitral valve regurgitation and the regurgitant jet was directed anteriorly swirling around the mass. The left ventricle dimensions and function were normal. 2D-Trans-esophageal Echocardiography(TEE) was done for better visualization of the mass and it"s attachment. The mass was overlying the atrial surface of the posterior leaflet middle P2 scallop with a small echo-lucent cavity (abscess formation) in the leaflet in addition to another smaller mass at the atrial surface of the anterior leaflet. The aortic, tricuspid and pulmonary valves were normal in structure and function Discussion Echocardiography is a crucial imaging modality in a patient with multiple systemic emboli to rule out cardio-embolic source of embolization. TEE is of added value along with TTE in better definition of masses and detection of IE related complication. While the patient was prepared for the vascular surgery to secure the ischemic limb his sensorium was disturbed and became unconscious immediate brain computed tomography showed severe intracranial hemorrhage and the patient died. Conclusions Patient with chronic kidney disease and on hemo-dialysis are highly vulnerable to health care related infective endocarditis and high clinical suspicion should be given in a situation of prolonged fever and embolic events. Mitral valve abscess is a rare complication of infective endocarditis and if occurs it leads to increase mortality. TEE should be an integral part of management of patients with IE to role out serious complications. Abstract P835 Figure. Mitral valve infective endocarditis

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MITRAL VALVE PROLAPSE AND INFECTIVE ENDOCARDITIS

The Lancet ◽

10.1016/s0140-6736(89)91539-0 ◽

1989 ◽

Vol 334 (8672) ◽

pp. 1165

Author(s):

R. Prassler ◽

Nicolas Danchin

Keyword(s):

Infective Endocarditis ◽

Mitral Valve ◽

Mitral Valve Prolapse

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Infective endocarditis and mitral valve prolapse—The unsuspected risk

Oral Surgery Oral Medicine Oral Pathology ◽

10.1016/0030-4220(82)90095-0 ◽

1982 ◽

Vol 54 (3) ◽

pp. 273-276 ◽

Cited By ~ 3

Author(s):

Susan E. Brackett

Keyword(s):

Infective Endocarditis ◽

Mitral Valve ◽

Mitral Valve Prolapse

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Can Infectious Endocarditis during Pregnancy Be Cured with Only Drug Treatment?

The Heart Surgery Forum ◽

10.1532/hsf.1226 ◽

2015 ◽

Vol 18 (1) ◽

pp. 033

Author(s):

Serhat Caliskan ◽

Feyzullah Besli ◽

Saim Sag ◽

Fatih Gungoren ◽

Ibrahim Baran

Keyword(s):

Infective Endocarditis ◽

Mitral Valve ◽

Mitral Regurgitation ◽

Mitral Valve Prolapse ◽

Treatment Options ◽

Blood Cultures ◽

Normal Vaginal Delivery ◽

Posterior Leaflet ◽

History Of ◽

Current Guidelines

During pregnancy, infective endocarditis (IE) is quite rare but has a high mortality rate in terms of the mother and the fetus. In this article, a 24-year-old patient with a history of mitral valve prolapse (MVP) who was hospitalized due to IE and treated successfully is presented. On echocardiography, severe mitral valve prolapse, severe mitral regurgitation, and vegetation on the posterior leaflet of mitral valve were observed. Streptococcus mitis was subsequently isolated from four sets of blood cultures. The patient was diagnosed with IE. After 6 weeks of antibiotic therapy, the patient was cured completely without surgical treatment. At 40-weeks of pregnancy, the patient gave birth via a normal vaginal delivery. There were no problems with the 3,800-gram baby born. In current guidelines, there is very limited advice on treatment options for patients who develop IE during pregnancy. Therefore, evaluation of patient-based treatment options would be appropriate. In addition, IE prophylaxis for MVP is not recommended in current guidelines. However, in MVP patients with mitral regurgitation, prior to procedures associated with a high risk of infective endocarditis, IE prophylaxis may be rational.

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