title: Paravalvular abscess of the mitral valve with fistula to the left ventricle and detachment of the coronary sinus in a young woman.
abstract: Infective endocarditis (IE) of the mitral valve (MV) manifesting paravalvular abscess (PA) is challenging. A 30-year-old woman presented with PA fistulating to the left ventricle, detachment of the coronary sinus and systemic embolization. During a course of fever of unknown origin, the patient received laparoscopic surgery under the diagnosis of strangulating intestinal obstruction due to colitis. Following abdominal surgery, abscess having blood flow within it from the left ventricle was pointed out at the left ventriculo-atrial junction by transthoracic echocardiography. Emergency surgery was performed under the diagnosis of PA of MV. Abscess debridement followed by reconstruction of the mitral annulus and coronary sinus with fresh autologous pericardium and mitral valve replacement (MVR) using a mechanical prosthetic valve were successfully performed. Timely and accurate diagnosis followed by the early surgical intervention with aggressive debridement of abscess and reconstruction with autologous pericardium should improve the outcome of this high-risk disease.
authors.affiliation: Department of Cardiovascular Surgery, Shinshu University School of Medicine, Matsumoto, Nagano, Japan.
authors.forename: Jun
authors.initials: J
authors.lastname: Amano
authors.forename: Kohei
authors.initials: K
authors.lastname: Takahashi
authors.forename: Tatsuichiro
authors.initials: T
authors.lastname: Seto
authors.forename: Takamitsu
authors.initials: T
authors.lastname: Terasaki
authors.forename: Yuko Fabish
authors.initials: YF
authors.lastname: Wada
authors.forename: Daisuke
authors.initials: D
authors.lastname: Fukui
authors.forename: Tamaki
authors.initials: T
authors.lastname: Takano
mesh_terms: D000038:Abscess / Q000382:microbiology / Q000601:surgery*; D000328:Adult; D006348:Cardiac Surgical Procedures / Q000379:methods*; D003092:Colitis / Q000601:surgery; D003646:Debridement; D004452:Echocardiography; D004696:Endocarditis / Q000382:microbiology / Q000601:surgery*; D005260:Female; D005402:Fistula / Q000382:microbiology / Q000601:surgery*; D006349:Heart Valve Diseases / Q000382:microbiology / Q000601:surgery*; D006801:Humans; D055624:Methicillin-Resistant Staphylococcus aureus; D008943:Mitral Valve / Q000601:surgery*; D013203:Staphylococcal Infections / Q000382:microbiology / Q000601:surgery*