title: Uncommon type of mitral insufficiency caused by perivalvular communication between left ventricle and left atrium.
abstract: This case report describes a patient with an uncommon type of mitral incompetence caused by a perivalvular communication between the left ventricle (LV) and the left atrium (LA) masked by a considerable fibrotic subvalvular aortic stenosis, endocarditis and congestive heart failure (CHF). A 64 year old farmer with a history of a systolic murmur since childhood complaining of increasing fatigue and dyspnoea, temperature over 39 degrees C, and signs of CHF was admitted and transferred to a cardiological unit. Invasive examination and continuing clinical deterioration caused urgent transfer for surgery under suspicion of a decompensated hypertrophic obstructive cardiomyopathy. Clinical investigation revealed a decompensated subvalvular aortic stenosis and a mild mitral insufficiency. At surgery the advanced fibrotic subvalvular stenosis was resected. After coming off bypass severe mitral insufficiency was detected by intraoperative analysis of the simultaneous intracavitary-pressure tracings. A midsystolic maximum of a high V-wave of the LA-pressure tracing was suggestive of an unusual reason of the mitral insufficiency. Reexploration indicated a perivalvular broad communication from the LA groove to the LV with an otherwise normal mitral valve. The communication was closed using buttressed mattress-sutures. This uncommon type of mitral incompetence via a perivalvular LA-LV communication was probably caused by endocarditis and an intramyocardial abscess in the LA-wall which subendocardially led to LV-LA communication.
authors.affiliation: Dept. of Thoracic and Cardiovascular Surgery, Heinrich-Heine University, Düsseldorf, FRG.
authors.forename: H D
authors.initials: HD
authors.lastname: Schulte
authors.forename: H
authors.initials: H
authors.lastname: Gramsch-Zabel
authors.forename: D
authors.initials: D
authors.lastname: Horstkotte
authors.forename: B
authors.initials: B
authors.lastname: Lösse
mesh_terms: D000038:Abscess; D001020:Aortic Stenosis, Subvalvular / Q000150:complications / Q000601:surgery; D004697:Endocarditis, Bacterial / Q000150:complications / Q000473:pathology; D006325:Heart Atria / Q000473:pathology; D006333:Heart Failure / Q000150:complications; D006352:Heart Ventricles / Q000473:pathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000473:pathology*; D008944:Mitral Valve Insufficiency / Q000209:etiology* / Q000601:surgery