Escherichia coli Infective Endocarditis Presented with Aorta-to-left Atrial Fistula and Mitral Valve Aneurysm Rupture: A Rare Clinical Finding

Abstract Funding Acknowledgements Nothing to disclose Background Mitral valve aneurysm is an uncommon sequelae of infective endocarditis (IE), early diagnosis and timely intervention is of paramount importance to prevent aneurysm rupture and hemodynamic deterioration. Clinical presentation A 25-years old gentleman with no known past medical history, presented with a history of unexplained fever for the past month partially responding to antipyretics along with exertional dyspnea. On examination he had a blood pressure of 120/80 mmHg, a heart rate of 110 bpm, a temperature of 39oC, a harsh pansystolic murmur over the apex and early diastolic murmur over the second aortic area. Laboratory results revealed anaemia, leukocytosis elevated ESR and CRP and blood cultures were positive for streptococcus viridians. Electrocardiography showed sinus tachycardia. Methods and results Trans-Thoracic Echocardiography (TTE) revealed the presence of an echolucent cavity measured 1.6x1.6 cm overlying a perforation of the anterior mitral valve leaflet (AML) a long with two small vegetations attached to the AML at the perforation edge, largest measures 0.8cm. There was a severe mitral valve regurgitation. The aortic valve is thickened trileaflet with lack of diastolic cooptation and evidence of severe regurgitation. The left ventricle dimensions were dilated and function was reduced, estimated LVEF = 50%. 3DTrans-esophageal Echocardiography(TEE) was done for better visualization of the mitral valve. The cavity involved A2 scallop, it was perforated and communicating with the LA with an additional regurgitation jet. The aortic valve showed no detectable masses or abscesses. Accordingly, patient was diagnosed with infective enfocarditis complicated with AML perforation and aneurysm formation, anti-biotics were commenced and patient was referred for double valve replacement. Discussion Mitral valve aneurysm most commonly occurs secondary to infective endocarditis of the aortic valve, while our patient does not demonstrate evidence of vegetations at the aortic valve but he had an unhealthy valve with severe regurgitation jet that hits AML and might by a cause of hit lesion at the AML and eventually complicated by aneurysm formation. Discussion Echocardiography is a crucial imaging modality in patient with long standing fever and underlying valvular heart disease to rule out infective endocarditis. 3D-TEE is of added value along with TTE in better definition of vegetations, detection of infective endocarditis complication and it has a crucial role in proper diagnosis and surgical planning for better clinical outcomes. Abstract P1693 Figure. Mitral valve aneurysm

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Extraskeletal Osteosarcoma of the Heart Presenting as Infective Endocarditis

Journal of the American Animal Hospital Association ◽

10.5326/jaaha-ms-5615 ◽

2011 ◽

Vol 47 (2) ◽

pp. 129-132 ◽

Cited By ~ 4

Author(s):

Jessica Timian ◽

Sean K. Yoshimoto ◽

David S. Bruyette

Keyword(s):

Heart Failure ◽

Infective Endocarditis ◽

Mitral Valve ◽

Left Atrial ◽

Acute Onset ◽

Initial Examination ◽

Extraskeletal Osteosarcoma ◽

Clinical Appearance ◽

Pulmonary Infiltrates ◽

Atrial Enlargement

A 7 yr old castrated male Labrador retriever (35.6 kg) was evaluated for an acute onset of vomiting of 24 hr duration. On initial examination, the patient was febrile (103.8°F) and tachycardic (150 beats/min). Thoracic radiographs revealed left atrial enlargement with mild pulmonary infiltrates. The dog's condition worsened and repeat radiographs revealed worsening pulmonary infiltrates and pleural effusion. Treatment for heart failure was initiated. An echocardiogram showed a large 3 cm × 4 cm vegetation on the atrial surface of the posterior mitral valve. The patient was euthanized due to poor clinical appearance and infective endocarditis was suspected. Necropsy revealed an osteosarcoma of the posterior mitral valve, which cultured negative.

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An unusual case report of mitral valve apparatus sparing left atrial appendage vegetation presenting as endogenous endophthalmitis

The Egyptian Heart Journal ◽

10.1186/s43044-021-00176-3 ◽

2021 ◽

Vol 73 (1) ◽

Author(s):

Rupesh Kumar ◽

Vidur Bansal ◽

Vikram Halder ◽

Nirupan Sekhar Chakraborty ◽

Krishna Prasad Gourav

Keyword(s):

Infective Endocarditis ◽

Mitral Valve ◽

Left Atrial ◽

Left Atrial Appendage ◽

Treatment Algorithm ◽

Atrial Appendage ◽

Definitive Treatment ◽

Endogenous Endophthalmitis ◽

Cardiac Symptoms ◽

Systemic Embolization

Abstract Background Ocular manifestations of infective endocarditis are nonspecific and rare. Endophthalmitis, retinal artery occlusion, Roth spots and vitreal and retinal infiltrations can all be seen with infective endocarditis. Also, infective endocarditis involving the left atrial appendage with no involvement of the mitral valve apparatus is a rarity. Case presentation Here we report a case of infective endocarditis of the heart involving the left atrial appendage presenting with features of endogenous endophthalmitis which ultimately progressed to phthisis bulbi with subtle cardiac symptoms in a previous healthy young adult. Conclusion Infective endocarditis involving the left chambers of the heart carries an inherent high risk of systemic embolization. Panophthalmitis which is considered to be the most severe form of endogenous endophthalmitis is a rare presenting feature. Although a definitive treatment algorithm is lacking, early surgery and parenteral antibiotics along with local antibiotic injections could help to save the vision.

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Left Atrial Wall Dissection: A Rare Sequela of Native-Valve Endocarditis

Texas Heart Institute Journal ◽

10.14503/thij-13-3989 ◽

2015 ◽

Vol 42 (2) ◽

pp. 178-180 ◽

Cited By ~ 5

Author(s):

Marwan Saad ◽

Ahmad Isbitan ◽

Alaa Roushdy ◽

Fayez Shamoon

Keyword(s):

Infective Endocarditis ◽

Mitral Valve ◽

Left Atrial ◽

Unusual Case ◽

Rare Condition ◽

Mitral Valve Surgery ◽

Atrial Wall ◽

Native Valve ◽

Cardiac Procedures ◽

Left Atrial Wall

Left atrial wall dissection is a rare condition; most cases are iatrogenic after mitral valve surgery. A few have been reported as sequelae of blunt chest trauma, acute myocardial infarction, and invasive cardiac procedures. On occasion, infective endocarditis causes left atrial wall dissection. We report a highly unusual case in which a 41-year-old man presented with native mitral valve infective endocarditis that had caused left atrial free-wall dissection. Although our patient died within an hour of presentation, we obtained what we consider to be a definitive diagnosis of a rare sequela, documented by transthoracic and transesophageal echocardiography.

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