SEPTIC MYOCARDIAL ANEURYSM IN ENDOCARDITI S AFFECTING THE MITRAL-VALVE - CLINICAL AND AUTOPSY FINDINGS

History and clinical findings: A 68-year-old woman was hospitalized be cause of fever and tiredness for 3 months. Met general condition was c learly impaired. She had a mild Fever of 38.5 degrees C and on auscult ation a 3/6 systolic murmur, maximal parasternally in the 3rd intercos tal space, transmitted to the apex. There were distant rales over bath lungs, the neck veins were distended and there was ankle oedema. Inve stigations: C-reactive protein was raised to 17.3 mg/dl (normal up to 0.9 mg/dl), WBC count 19,300/mu l. beta-haemolysing streptococcus (S. agalactiae) was grown in the blood culture. The ECG showed sinus tachy cardia (rate of 98/min) and transthoracic echocardiography demonstrate d a small pericardial, enlarged ventricles, marked mitras regurgitatio n and a large vegetation on the posterior mitral leaflet, as well as a 3 x 4 cm mass in the posterior wall of the ventricle, originating fro m the posterior mitral valve ring and communicating with the vegetatio n on the mitral valve. The posterior mitral leaflet was perforated. Tr eatment and course: As endocarditis of the mitral valve with a complic ated course was suspected - abscess of the posterior mitral valve ring and septic myocardial aneurysm with associated pericarditis and haemo dynamically insignificant effusion - she was transferred to the intens ive care unit where she died suddenly of circulatory arrest only 30 mi n after transfer. autopsy confirmed the echocardiographic findings. Co nclusion: Paravalvar abscess in the course of mitral valve endocarditi s is rare, but should be looked for at transthoracic echocardiography so that any necessary surgical intervention can be untertaken early.