Bacterial endocarditis complicating mitral annular calcification: a clinical and echocardiographic study.
OBJECTIVE
Although described in a number of necropsy studies, endocarditis on mitral annular calcification (MAC) has rarely been reported during life. The study aim was to assess the frequency and specific features of bacterial endocarditis complicating MAC.


METHODS
Data relating to 62 cases of infective endocarditis of the native mitral valve diagnosed with multiplane transesophageal echocardiography (TEE) over a five-year period were collected prospectively.


RESULTS
Among 62 patients, 15 (24%) had vegetations originating from a calcified mitral annulus (group 1), while 47 had classic leaflet endocarditis (group 2). Group 1 patients differed significantly from group 2 patients with regard to: (i) higher incidence of diabetes mellitus and cancers; (ii) initial clinical presentation, with febrile coma or meningoencephalitis in 53% of cases; (iii) echocardiographic features, with significantly greater vegetations, presence of calcium-dense echoes within the vegetation, high frequency of ring abscess, and high frequency of para-annular ventriculoatrial leakage; and (iv) poorer clinical outcome, with 53% in-hospital mortality.


CONCLUSIONS
MAC appears to be an underestimated predisposing factor for a particularly severe type of bacterial endocarditis. The use of multiplane TEE should improve current knowledge of this disease.
Eicher
Jean-Christophe
JC
Department of Cardiology, University Hospital, Dijon, France. jean-christophe.eicher@chu-dijon.fr
De Nadai
Laurence
L
Soto
Francois-Xavier
FX
Falcon-Eicher
Sylvie
S
Dobsák
Petr
P
Zanetta
Gilbert
G
Petit
Jean-Michel
JM
Portier
Henry
H
Louis
Pierre
P
Wolf
Jean-Eric
JE
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000097:blood; D002114:Calcinosis / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000382:microbiology*; D006348:Cardiac Surgical Procedures; D004452:Echocardiography; D017548:Echocardiography, Transesophageal; D004697:Endocarditis, Bacterial / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000382:microbiology*; D005260:Female; D006349:Heart Valve Diseases / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000382:microbiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000000981:diagnostic imaging / Q000382:microbiology*; D010343:Patient Admission; D011183:Postoperative Complications / Q000209:etiology / Q000401:mortality; D015995:Prevalence; D011446:Prospective Studies; D013203:Staphylococcal Infections / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000382:microbiology*; D013290:Streptococcal Infections / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000382:microbiology*; D016896:Treatment Outcome
D015415:Biomarkers