Severe Aortic Regurgitation by Nonbacterial Thrombotic Endocarditis Treated with Anticoagulation Therapy
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ABSTRACT:
SUBMITTER: Murata A
PROVIDER: S-EPMC9271484 | biostudies-literature |
REPOSITORIES: biostudies-literature
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Project description:Highlights•NBTE can present with extensive tissue destruction warranting complex surgeries.•Echocardiography is crucial in guiding the surgical plan and detecting complications.•The cardiac skeleton can be surgically reconstructed, but complications are high.
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Project description:We describe the case of a 43-year-old woman with transient ischemic neurologic deficits and recurrent systemic and pulmonary emboli in whom infectious work-up and extensive thrombophilic evaluation were unremarkable. Transesophageal echocardiography (TEE) established the diagnosis of nonbacterial thrombotic endocarditis (NBTE). This is a rare condition often associated with hypercoagulable states or advanced malignancy such as adenocarcinomas, characterized by cardiac vegetations along valvular coaptation lines without destruction of leaflets. In our patient, we diagnosed an ovarian clear cell adenocarcinoma, a malignant disorder that has been rarely reported in association with NBTE. This case illustrates that NBTE can present as an atypical manifestation of malignancy and must be distinguished from infective endocarditis, which implies a different therapeutic strategy. When confronted with findings of NBTE without a clear etiology, an occult neoplasm must be excluded. Anticoagulant therapy is the mainstay of treatment. However, cardiac vegetations may require surgical intervention in rare instances.
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Project description:We present the case of a 76-year-old man with recently treated infective endocarditis and severe residual native pure aortic regurgitation that was causing recurrent pulmonary edema. In view of his prohibitive surgical risk, he underwent transcatheter aortic valve implant with an excellent clinical outcome. (Level of Difficulty: Intermediate.).
| S-EPMC8311271 | biostudies-literature
Project description:BackgroundRheumatoid arthritis (RA) may involve the cardiovascular system and can cause significant structural cardiac disease. RA mimicking infective endocarditis (IE) is rarely reported.Case summaryA 46-year-old man with a medical history of seropositive RA attended a planned outpatient visit for infliximab treatment. The pre-infusion examination revealed a pulse of 41 b.p.m. and the following electrocardiogram showed 3rd degree atrioventricular block. A temporary pacemaker was inserted, and subsequent transthoracic and transoesophageal echocardiograms showed severe aortic valve regurgitation with thickened cusps and thus raised suspicion of infective aortic endocarditis with root abscess. The patient underwent surgery with valve and root replacement the next day. What was thought to be IE, proved to be suppurative and granulomatous inflammation with sporadic necrosis and hyaline fibrosis, compatible with a rheumatoid nodule linked to the patient's RA diagnosis.DiscussionIE is a disease with high mortality and morbidity. In some cases of IE perivalvular cavities develop, most commonly abscesses and/or pseudoaneurysms, which necessitates surgery. Several conditions may mimic IE: for example, malignant and benign tumours, rheumatic diseases, and common age-related valve calcification. In patients with valvular vegetations that are 'culture-negative', alternative pathologies should be considered.
| S-EPMC7898585 | biostudies-literature
Project description:Nonbacterial thrombotic endocarditis (NBTE) is characterized by the deposition of thrombi on the heart valves without bacteremia and predominantly affects patients with hypercoagulable state. Since the lesion of NBTE often exists in the left-sided valves, involvement of the tricuspid valve (TV) is rare. We herein report a 34-year-old woman with advanced ovarian cancer and pulmonary embolization showing NBTE on the TV. Plasma D-dimer level was markedly elevated and echocardiography showed highly mobile masses on the TV with moderate to severe regurgitation. After the initiation of heparin therapy, reduction of plasma D-dimer levels along with shrinkage of the TV vegetations was observed. However, she was forced to discontinue the heparin because its supply was interrupted in association with coronavirus disease 2019. Coupled with systemic metastasis of ovarian cancer, elevated plasma D-dimer level and exacerbation of NBTE were observed. Thereafter, she resumed subcutaneous injection of heparin, resulting in re-improvement.Learning objectiveInvolvement of tricuspid valve (TV) by nonbacterial thrombotic endocarditis (NBTE) is rare, especially when they are associated with advanced cancer. Our case underlines the importance of listing the NBTE as a differential diagnosis in cancer patients showing valve vegetations even in the TV.
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Project description:BackgroundSystemic lupus erythematosus (SLE) valvulopathy can manifest as a spectrum of pathologies and treatment of severe valvular dysfunction thus far has been surgical. However, surgery in patients with SLE is frequently associated with high morbidity and mortality due to the presence of significant co-morbidities.Case summaryWe report the case of a 41-year-old woman with SLE and anti-phospholipid syndrome with extensive co-morbidities including lupus nephritis, pancytopaenia, cerebrovascular accident, and severe airway obstruction from ipsilateral lung collapse and bronchiectasis. She had severe mitral regurgitation (MR) from Libman-Sacks endocarditis and in recent months developed heart failure with progressive exertional dyspnoea from New York Heart Association (NYHA) functional Class from New York Heart Association (NYHA) functional class II to III. In addition, there was progressive left ventricular dilatation and reduction in left ventricular ejection fraction. In view of the high surgical risk, she underwent transcatheter edge-to-edge repair (TEER) of the mitral valve with the MitraClip system. At 1-month follow-up, she was back to NYHA functional Class II with mild MR.DiscussionOur case demonstrates that in select patient with suitable anatomy, TEER is a potential treatment option for severe MR from SLE valvulopathy.
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Project description:A 67-year-old man with myelodysplastic syndrome, disseminated histoplasmosis, and mitral valve replacement presented with dyspnea and peripheral edema. Transthoracic echocardiography demonstrated abnormal pulmonic valve with possible vegetation. Color flow imaging showed laminar flow from main pulmonary artery into right ventricular outflow tract (RVOT) in diastole. The continuous wave Doppler signal showed dense diastolic envelope with steep deceleration slope. These findings were consistent with severe pulmonic valve regurgitation, possibly due to endocarditis. Transesophageal echocardiography demonstrated an echodense mass attached to the pulmonic valve. The mitral valve bioprosthesis appeared intact. Bacterial and fungal blood cultures were negative; however, serum histoplasma antigen was positive. At surgery, the valve appeared destroyed by vegetations. Gomori methenamine silver-stains showed invasive fungal hyphae and yeast consistent with a dimorphic fungus. Valve cultures grew one colony of filamentous fungus. Itraconazole was continued based on expert infectious diseases diagnosis. After surgery, dyspnea and ankle edema resolved. To the best of our knowledge, histoplasma endocarditis of pulmonic valve has not been previously reported. Isolated pulmonic valve endocarditis is rare, accounting for about 2% of infectious endocarditis (IE) cases. Fungi account for about 3% of cases of native valve endocarditis. Characterization of pulmonary valve requires thorough interrogation with 2D and Doppler echocardiography techniques. Parasternal RVOT view allowed visualization of the pulmonary valve and assessment of regurgitation severity. As an anterior structure, it may be difficult to image with transesophageal echocardiography. Mid-esophageal right ventricular inflow-outflow view clearly showed the pulmonary valve and vegetation.Identification and characterization of pulmonary valve abnormalities require thorough interrogation with 2D and Doppler echocardiography techniques.Isolated pulmonary valve IE is rare and requires high index of suspicion. Histoplasma capsulatum IE is rare and requires high index of suspicion.
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Project description:We describe a patient with symptoms of heart failure caused by severe mitral regurgitation. Echocardiography revealed an intracardiac mass embedding the posterior mitral valve leaflet, and cardiac magnetic resonance imaging showed two intracardiac thrombi and endomyocardial fibrosis. Eosinophil count kept rising and a mutation in the gene for platelet-derived growth factor receptor alpha was found. The combination of these findings led to the diagnosis of Loeffler's endocarditis. Treatment with prednisone and a tyrosine kinase inhibitor resulted in complete remission of the hypereosinophilia and mitral valve regurgitation was only mild at 9-month follow-up visit. <Learning objective: This case report presents a patient with severe mitral regurgitation and heart failure due to hypereosinophilic syndrome (HES). It leads to thrombus formation and endomyocardial thickening due to eosinophilic infiltration of the myocardium. Treatment with steroids and a tyrosine kinase inhibitor led to clinical improvement and only mild mitral regurgitaton after 6 months. Loeffler's endomyocarditis is a model disease for restrictive cardiomyopathy. It is important to recognize and treat this disease early and prevent morbidity and mortality. As far as we know there is no previous case report that describes the reversibility of severe mitral regurgitation after pharmacological treatment of HES, not needing mitral valve replacement.>.
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