Culture‐Negative Suppurative Endocarditis Causing Severe Mitral Valve Obstruction: Complementary Use of Transesophageal and Transthoracic Echocardiography

Roychoudhury, Debasish; Chaithiraphan, Vithaya; Stathopoulos, Ioannis; Fergus, Icilma; Tortólani, Anthony J.; Murkis, Marina A.; Messineo, Frank C.

doi:10.1046/j.1540-8175.2003.03080.x

Cited by 5 publications

(1 citation statement)

References 22 publications

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“…Stenosis of the mitral valve is usually observed as a late complication of rheumatic fever. Mitral stenosis due to reasons other than rheumatic fever is an uncommon occurrence and is usually encountered in sporadic cases secondary to infective endocarditis which causes functional stenosis from obstructive vegetations (13)(14)(15).…”

Section: Introductionmentioning

confidence: 99%

Demonstration of Chlamydophila pneumoniae, Mycoplasma pneumoniae, Cytomegalovirus, and Epstein-Barr virus in atherosclerotic coronary arteries, nonrheumatic calcific aortic and rheumatic stenotic mitral valves by polymerase chain reaction

Bayram¹,

Erdoğan²,

Ekşi³

et al. 2011

Anadolu Kardiyol Derg

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Objective: The aim of this study was to investigate whether bacterial and viral infectious agents can be demonstrated in atherosclerotic lesions of patients with coronary artery disease (CAD) as well as in stenotic aortic and mitral valves from patients undergoing heart valve replacement. Methods: In this cross-sectional study, the presence of Chlamydophila pneumoniae, Mycoplasma pneumoniae, Cytomegalovirus (CMV), and Epstein-Barr virus (EBV) was investigated by polymerase chain reaction in atherosclerotic and non-atherosclerotic vascular samples taken from patients undergoing coronary artery bypass surgery due to CAD, and from patients undergoing aortic (AVR) and/or mitral valve replacement (MVR) secondary to valvular stenosis. For statistical analyses ANOVA, Chi-square test or Fisher's exact test were used. Results: The presence of C. pneumoniae, M. pneumoniae, and CMV in atherosclerotic versus non-atherosclerotic samples was as follows: 30% vs. 16.7% (p=0.222), 6.7% vs. 3.3% (p=0.554), and 10% vs. 0% (p=0.076), respectively. In valve group, same pathogens were present in AVR and MVR patients as follows: 24.2% vs. 21. 4% (p=0.773), 9.1% vs. 7.1% (p=0.758), and 21.2% vs. 11.9% (p=0.275). EBV DNA was not detected in any of vascular specimens, but in one (3%) patient with AVR (p=0.256). Conclusion: Our results suggest that C. pneumoniae, M. pneumoniae, and CMV are present with similar frequency both in atherosclerotic and non-atherosclerotic vessels. We conclude that although non-atherosclerotic, vascular samples of CAD patients are invaded by infectious agents as like as atherosclerotic vessels. We further conclude that C. pneumoniae, M. pneumoniae, and CMV are present in stenotic aortic and mitral valves and atherosclerotic tissues with similar frequency indicating that atherosclerosis and valvular stenosis might share a common etiology related to infection. (Anadolu Kardiyol Derg 2011; 11: 237-43)

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Section: Introductionmentioning

confidence: 99%

Demonstration of Chlamydophila pneumoniae, Mycoplasma pneumoniae, Cytomegalovirus, and Epstein-Barr virus in atherosclerotic coronary arteries, nonrheumatic calcific aortic and rheumatic stenotic mitral valves by polymerase chain reaction

Bayram¹,

Erdoğan²,

Ekşi³

et al. 2011

Anadolu Kardiyol Derg

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Infective endocarditis

Kessenich

Flanagan

2014

The Nurse Practitioner

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Infective endocarditis causing mitral valve stenosis – a rare but deadly complication: a case report

Hart

Shroff

2017

J Med Case Reports

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BackgroundInfective endocarditis rarely causes mitral valve stenosis. When present, it has the potential to cause severe hemodynamic decompensation and death. There are only 15 reported cases in the literature of mitral prosthetic valve bacterial endocarditis causing stenosis by obstruction. This case is even more unusual due to the mechanism by which functional mitral stenosis occurred.Case presentationWe report a case of a 23-year-old white woman with a history of intravenous drug abuse who presented with acute heart failure. Transthoracic echocardiography failed to show valvular vegetation, but high clinical suspicion led to transesophageal imaging that demonstrated infiltrative prosthetic valve endocarditis causing severe mitral stenosis. Despite extensive efforts from a multidisciplinary team, she died as a result of her critical illness.ConclusionsThe discussion of this case highlights endocarditis physiology, the notable absence of stenosis in modified Duke criteria, and the utility of transesophageal echocardiography in clinching a diagnosis. It advances our knowledge of how endocarditis manifests, and serves as a valuable lesson for clinicians treating similar patients who present with stenosis but no regurgitation on transthoracic imaging, as a decision to forego a transesophageal echocardiography could cause this serious complication of endocarditis to be missed.Electronic supplementary materialThe online version of this article (doi:10.1186/s13256-017-1197-3) contains supplementary material, which is available to authorized users.

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Culture‐Negative Suppurative Endocarditis Causing Severe Mitral Valve Obstruction: Complementary Use of Transesophageal and Transthoracic Echocardiography

Cited by 5 publications

References 22 publications

Demonstration of Chlamydophila pneumoniae, Mycoplasma pneumoniae, Cytomegalovirus, and Epstein-Barr virus in atherosclerotic coronary arteries, nonrheumatic calcific aortic and rheumatic stenotic mitral valves by polymerase chain reaction

Demonstration of Chlamydophila pneumoniae, Mycoplasma pneumoniae, Cytomegalovirus, and Epstein-Barr virus in atherosclerotic coronary arteries, nonrheumatic calcific aortic and rheumatic stenotic mitral valves by polymerase chain reaction

Infective endocarditis

Infective endocarditis causing mitral valve stenosis – a rare but deadly complication: a case report

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