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Open Access Highly Accessed Case report

Left atrial endocarditis as a rare complication of mitral valve endocarditis: a clinical case

Ali Hamadanchi1, Wolfgang Bothe2, Alexander Pfeil3, Azita Abdi Rad4, Bernhard R Brehm1, Hans R Figulla1, Thorsten Doenst2, Marcus Franz1 and Christian Jung1*

Author Affiliations

1 Department of Cardiology, University Hospital Jena, Erlanger Allee 101, D-07747, Jena, Germany

2 Department of Cardiothoracic Surgery, University Hospital Jena, Jena, Germany

3 Department of Internal medicine III, University Hospital Jena, Jena, Germany

4 Institute of Pathology, University Hospital Jena, Jena, Germany

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BMC Cardiovascular Disorders 2012, 12:103  doi:10.1186/1471-2261-12-103

Published: 15 November 2012

Abstract

Background

Infective Endocarditis (IE) is considered as a multifaceted problem in every aspect from etiology and presentation to diagnosis and management. Early recognition of this disease and especially its complications, remain a critical task for the cardiologist. Atrial endocarditis is a rare and sometimes unrecognized complication of mitral valve endocarditis.

Case presentation

We present a 48 year-old male patient who was admitted to our clinic because of recent onset of malaise, fever, jaundice and peripheral edema. Important physical findings were peripheral stigmata of IE in addition to holosystolic murmur over the left sternal border. Transthoracic and transesophageal echocardiophy revealed a severe eccentric MR due to a flailed posterior mitral valve caused by IE. The presence of atrial septal endocarditis caused by jet streaming was also observed. Blood culture was positive for streptococcus oralis and antibiotic therapy was immediately initiated. Considering the large burden of infective tissue, the patient was planned for an early surgical intervention. A minimally invasive resection of the atrial mass, direct closure of the defect, resection of the diseased portions of mitral leaflets and implantation of a biological mitral valve prosthesis was performed. Intra-operative and histological findings confirmed provisional diagnosis by echocardiography.

Conclusions

Together with comprehensive echocardiographic evaluation, attention should be placed on mural vegetations and excluded among all cases of mitral valve endocarditis, particularly those with severe eccentric regurgitant jets.