J Cardiovasc Ultrasound.  2008 Sep;16(3):84-86. 10.4250/jcu.2008.16.3.84.

Left Atrial Mural Endocarditis Diagnosed by Transesophageal Echocardiography in a Patient with Mitral Valve Prolapse

Affiliations
  • 1Division of Cardiology, Department of Internal Medicine, Daegu Catholic University Medical Center, Daegu, Korea. kks7379@cu.ac.kr

Abstract

Infective endocarditis (IE) is one of the major complications of the mitral valve prolapse (MVP) syndrome and usually involves mitral valve (MV) and its accessory apparatus. Left atrial (LA) mural endocarditis is a condition of rarely diagnosed and the most feasible mechanism is related to the impact of regurgitant jet that causes endothelial damage and retrograde microorganisms dissemination. Echocardiography is essential in diagnosis and treatment of IE but in mural endocarditis, it may be difficult to find vegetation by standard view of transthoracic echocardiography (TTE). We report a case of LA mural endocarditis which was diagnosed by transesophageal echocardiography (TEE) in a patient with MVP.

Keyword

Mural endocarditis; Mitral valve prolapse; Transesophageal echocardiography

MeSH Terms

Echocardiography
Echocardiography, Transesophageal
Endocarditis
Humans
Mitral Valve
Mitral Valve Prolapse

Figure

  • Fig. 1 Transesophageal echocardiography. Anterior leaflet of mitral valve (arrow) is thickened and myxomatous and is displaced into the LA during systole. LA: left atrium, LV: left ventricle.

  • Fig. 2 A: Slightly modified transesophageal long axis view shows eccentric jet flow of mitral regurgitation due to mitral valve prolapse. B: Arrow point to the vegetation located on the myocardial wall of the posterior aspect of the left atrium where the jet of mitral regurgitation is directed. LA: left atrium, LV: left ventricle.

  • Fig. 3 Large vegetation (black arrow) is attached to LA posterior wall just above the posterior mitral leaflet and the distal part (white arrow) is freely moving according to heart beat and regurgitant jet. LA: left atrium, LV: left ventricle.

  • Fig. 4 Intraoperative finding shows several vegetations (arrow) attached to the posterior wall of left atrium.


Reference

1. Ringer M, Feen DJ, Drapkin MS. Mitral valve prolapse: jet stream causing mural endocarditis. Am J Cardiol. 1980. 45:383–385.
Article
2. Bierbrier GS, Novick RJ, Guiraudon C, Wisenberg G, Boughner D. Left atrial bacterial mural endocarditis. Chest. 1991. 99:757–759.
Article
3. Shirani J, Keffler K, Gerszten E, Gbur CS, Arrowood JA. Primary left ventricular mural endocarditis diagnosed by transesophageal echocardiography. J Am Soc Echocardiogr. 1995. 8:554–556.
Article
4. Moaref AR, Mollazadeh R, Zamirian M, Sharifkazemia MB. Rapid progression of aortic wall vegetation. J Am Soc Echocardiogr. 2008. 21:297.e1–297.e2.
Article
5. Daniel WG, Mügge A, Grote J, Hausmann D, Nikutta P, Laas J, Lichtlen PR, Martin RP. Comparison of transthoracic and transesophageal echocardiography for detection of abnormalities of prosthetic and bioprosthetic valves in the mitral and aortic positions. Am J Cardiol. 1993. 71:210–215.
Article
6. Mylonakis E, Calderwood SB. Infective endocarditis in adults. N Engl J Med. 2001. 345:1318–1330.
Article
7. Duren DR, Becker AE, Dunning AJ. Long-term follow-up of idiopathic mitral valve prolapse in 300 patients: a prospective study. J Am Coll Cardiol. 1988. 114:42–47.
8. Zuppiroli A, Rinaldi M, Kramer-Fox R, Favilli S, Roman MJ, Devereux RB. Natural history of mitral valve prolapse. Am J Cardiol. 1995. 75:1028–1032.
Article
9. Kim MK, Song JK, Kang DH, Lee JH, Cho YH, Park KH, Ko KH, Yoon YJ, Kim JJ, Park SW, Park SJ. Recent trends and clinical outcomes of infective endocarditis. Korean J Med. 2000. 58:28–38.
10. Avierinos JF, Gersh BJ, Melton LJ III, Bailey KR, Shub C, Nishimura RA, Tajik AJ, Enriquez-Sarano M. Natural history of asymptomatic mitral valve prolapse in the community. Circulation. 2002. 106:1355–1361.
Article
11. Clemens JD, Horwitz RI, Jaffe CC, Feinstein AR, Stanton BF. A controlled evaluation of the risk of bacterial endocarditis in persons with mitral-valve prolapse. N Engl J Med. 1982. 307:776–781.
Article
12. MacMahon SW, Roberts JK, Kramer-Fox R, Zucker DM, Roberts RB, Devereux RB. Mitral valve prolapse and infective endocarditis. Am Heart J. 1987. 113:1291–1298.
Article
13. Hayek E, Gring CN, Griffin BP. Mitral valve prolapse. Lancet. 2005. 365:507–518.
Article
14. Gregory SA, Yepes CB, Byrne JG, D'Ambra MN, Chen MH. Atrial endocarditis--the importance of the regurgitant jet lesion. Echocardiography. 2005. 22:426–430.
Article
Full Text Links
  • JCU
Actions
Cited
CITED
export Copy
Close
Share
  • Twitter
  • Facebook
Similar articles
Copyright © 2024 by Korean Association of Medical Journal Editors. All rights reserved.     E-mail: koreamed@kamje.or.kr