Getting to the Heart of the Matter

Abstract

A 60-year-old woman returned from visiting a cousin in Texas. For the past 6 weeks, she had not been feeling well and had lost almost 30 lb. She had frequent night sweats, although she did not recall having taken her temperature. Upon evaluation in the emergency department, results of physical examination were notable for cachexia and poor dentition. She was noted to have pyuria, and therapy was initiated for a urinary tract infection. Results of blood cultures performed the same day were positive for gram-positive cocci, and vancomycin therapy was initiated. She developed difficulty in seeing to her, left and a computed tomographic scan of the brain was performed; results were interpreted as negative. A transesophageal echocardiogram showed a 3-cm mass attached the posterior leaflet of the mitral valve. Initial interpretation was of an atrial myxoma. One of the authors was asked to consult on the case and noted bilateral conjunctival hemorrhages (Figure 1). Subsequently, the blood culture isolate was identified as Streptococcus mitis. Magnetic resonance imaging confirmed multiple cerebral infarcts consistent with embolic origin. The patient underwent emergent cardiac surgery, and her mitral valve was replaced with a bioprosthetic valve. She successfully completed a 4-week course of antibiotic therapy for her endocarditis.

Infected cardiac myxoma: an updated review

“…Their information was listed in Table 1 . According to the diagnostic criteria of infected cardiac myxoma, 34 (87.2%) were definite [ 3 - 36 ] , 4 (10.3%) were probable [ 37 - 40 ] and 1 (2.6%) was possible [ 41 ] , with a compatible distribution of the three-level infected cardiac myxomas reported by Revankar & Clark [ 2 ] . The locations of the infected cardiac myxomas were left atrium 27 (69.2%), right atrium 5 (12.8%), mitral valve 5 (12.8%), right ventricle 1 (2.6%) and unstated 1 (2.6%), also similar to the percentages of the locations reported by Revankar & Clark [ 2 ] .…”

Massa Valvar Mitral em Paciente com Suspeita de Lúpus Sistêmico: Tumor, Endocardite ou Ambos?

“…2 O presente caso parece ser o sexto de mixoma valvar mitral infectado relatado na literatura, preenchendo critérios definitivos para o diagnóstico, e o terceiro causado por um microrganismo do grupo HACEK (Tabela 1). [3][4][5][6][7][8] Dos 64 mixomas valvares mitrais publicados de 2006 a 2012, os sintomas eram cardiovasculares em 36,7%; 9,5 a 21,6% dos mixomas da válvula mitral foram submetidos à troca valvar e o tempo do diagnóstico até a cirurgia variou de algumas horas a 42 dias. 2,9 A mortalidade operatória e geral foi relatada como sendo, respectivamente, 2,6 a 3% e 5,1 a 21%.…”

“… 2 The present case appears to be the sixth reported infected mitral valve myxoma by fulfilling previously published definitive criteria and the third caused by a microorganism from the HACEK group ( table 1 ). 3 - 8 Of 64 mitral valve myxomas published from 2006 to 2012, symptoms were cardiovascular in 36,7%; 9.5 to 21.6% of mitral valve myxomas underwent valve replacement and the timing until surgery varied from a few hours to 42 days. 2 , 9 Operative and overall mortality was reported to be respectively 2.6 to 3% and 5.1 to 21%.…”