Author + information
- Received August 19, 2009
- Accepted September 17, 2009
- Published online July 6, 2010.
- Hector I. Michelena, MD*,
- Rakesh M. Suri, MD, PhD†,
- Maurice Enriquez-Sarano, MD* and
- Joseph Dearani, MD†
An 81-year-old female with prior history of rheumatoid arthritis on immunosuppressants was admitted to our institution with fever, altered mental status, and leucocytosis. She had been recently discharged from the hospital after open correction of a right ankle fracture. Blood cultures were positive for Staphylococcus aureus. The patient developed acute hypoxemic respiratory failure requiring intubation, and a transthoracic echocardiogram revealed new severe mitral valve regurgitation (MR) of unclear etiology. Transesophageal echocardiogram showed mitral valve perforation or flail of the posteromedial commissure (A, arrows, Online Video 1) with torrential mitral valve regurgitation (A, Online Video 1), but it is unclear whether the involved segment was P3, A3, or both. Real-time intraoperative 3-dimensional transesophageal echocardiogram from the “surgeon's view” revealed a ruptured mycotic aneurysm of the medial scallop of the anterior leaflet (B, arrow)opening in systole and closing in diastole (B, Online Videos 2and 3) in a wind-sock fashion, with a smaller contiguous aneurysm (B, *). The anterior leaflet was removed and pathological correlation is shown (C). The patient underwent mitral valve replacement with resolution of heart failure. A1 = lateral scallop; A2 = middle scallop; AL = anterior mitral leaflet; LA = left atrium; LV = left ventricle; PL = posterior mitral leaflet.
- Received August 19, 2009.
- Accepted September 17, 2009.
- American College of Cardiology Foundation