title: [Mitral obstruction due to infective endocarditis: a case report].
abstract: Acute valvular obstruction caused by vegetation is a rare complication infective endocarditis. To our knowledge, only 9 cases and an autopsy case by Roberts have been reported since 1967. A 46-year-old man admitted with a chief complaint of pyrexia for 2 months duration. Within 24 hours of admission, the patient noticed of increased shortness of breath. Physical examination and the chest X-ray confirmed the pulmonary edema. An echocardiogram revealed a huge echogenic mass that was adherent to the mitral leaflet and obstructed the orifice completely. Soon after the patient fell into cardiogenic shock, an emergency mitral valve replacement was undertaken. At operation, multiple verrucae arising from the entire mitral leaflet was seen to occlude the orifice. The vegetation was excised and replaced with a # 25 Omnicarbon prosthesis. Postoperatively, the patient developed multiple organ failure caused by cardiogenic and septic shock which responded well to intensive medical treatment consisting of hemodialysis and continuous arteriovenous hemofiltration. Angiographically, a mycotic aneurysm in the left radial artery was found on the 18th postoperative day. After extirpation of the infective focuses, the postoperative course had stabilized. Mitral obstruction due to infective endocarditis is a fatal disease. Prompt diagnosis with echocardiogram and an emergency surgery should be undertaken to save the patient.
authors.affiliation: Department of Cardiovascular and Thoracic Surgery, Dokkyo University Koshigaya Hospital, Koshigaya, Japan.
authors.forename: Y
authors.initials: Y
authors.lastname: Irie
authors.forename: T
authors.initials: T
authors.lastname: Yamada
authors.forename: N
authors.initials: N
authors.lastname: Oshima
authors.forename: Y
authors.initials: Y
authors.lastname: Katayama
authors.forename: E
authors.initials: E
authors.lastname: Sano
authors.forename: S
authors.initials: S
authors.lastname: Nagasawa
mesh_terms: D004697:Endocarditis, Bacterial / Q000150:complications*; D006349:Heart Valve Diseases / Q000209:etiology / Q000601:surgery; D006350:Heart Valve Prosthesis; D006801:Humans; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000601:surgery; D013927:Thrombosis / Q000209:etiology* / Q000601:surgery