Myocardial Complications of Acute Mitral Valve Endocarditis
A33-year-old HIV-positive intravenous drug addict required urgent mitral valve replacement for acute Staphylococcus aureus endocarditis complicated by severe mitral regurgitation, cardiogenic shock, sepsis, systemic embolizations, and stroke. Intraoperative examination revealed a large vegetation and partial destruction of the posterior leaflet with some ruptured chordae (A). Two mycotic aneurysms (short arrows, B and C) were found in the diagonal branch (Dg) of the left anterior descending coronary artery (LAD), and several 2- to 10-mm yellowish intramyocardial changes were noted in the lateral wall of the left ventricle (arrowhead, C). One of them was excised and diagnosed on histopathological examination as epimyocarditis with myocardial abscesses. Several small myocardial infarctions 3 to 10 mm in diameter (arrowheads, D) were noted at the inferior surface of the left ventricle in the region supplied by the marginal branches of the left circumflex coronary artery. The mitral valve was replaced with a bioprosthetic valve (No. 29) after partial excision of the leaflet that had changes. The patient recovered after a prolonged postoperative course characterized by multiple complications and residual neurological sequelae.
The editor of Images in Cardiovascular Medicine is Hugh A. McAllister, Jr, MD, Chief, Department of Pathology, St Luke’s Episcopal Hospital and Texas Heart Institute, and Clinical Professor of Pathology, University of Texas Medical School and Baylor College of Medicine.
Circulation encourages readers to submit cardiovascular images to Dr Hugh A. McAllister, Jr, St Luke’s Episcopal Hospital and Texas Heart Institute, 6720 Bertner Ave, MC1–267, Houston, TX 77030.
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