Js. Meisner et al., AORTIC VEGETATIVE PERFORATION OF THE MITRAL-VALVE - A NEW MECHANISM FOR SPREAD OF ENDOCARDITIS, Journal of cardiovascular diagnosis and procedures, 14(2), 1997, pp. 59-61
Citations number
7
Categorie Soggetti
Radiology,Nuclear Medicine & Medical Imaging","Cardiac & Cardiovascular System
We report the case of a man presenting with a stroke and new heart mur
murs 6 weeks after surgery for a malignancy of the colon and urosepsis
with blood cultures positive for Streptococcus sanguis. A small echog
enic density and a central jet of aortic insufficiency were the only s
ignificant findings on transthoracic echocardiographic examination. Tr
ansesophageal echocardiography disclosed a filamentous vegetation of t
he left coronary cusp of the aortic valve, which penetrated through a
fenestration of the anterior leaflet of the mitral valve. Spread of en
docarditis from aortic to mitral valves has been explained by burrowin
g of infection through the intervalvular fossa and by seeding of the m
itral valve by a regurgitant jet from the incompetent aortic valve. Th
is is the first report of spread of endocarditis by repeated direct co
ntact and erosion of the mitral valve by a prolapsing aortic vegetatio
n. This case supports the use of transesophageal echocardiography to i
nspect completely the mitral valve in the setting of endocarditis of t
he aortic valve and to evaluate the aortic valve when endocarditis of
the mitral valve is suspected.