Mitral valve vegetation progression
by Nanda Navin C

Comprehensive Textbook of Echocardiography

by Navin C Nanda
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Sequential transesophageal echocardiographic examination in a 52-year-old male patient with methicillin resistant Staphylococcus aureus infection. Day 1: shows a large mobile vegetation involving the mitral valve. Appropriate antibiotic therapy was instituted. Day 5: the vegetation was seen for the first time extending to involve the left atrial free wall. Day 6: intraoperative and pre- bypass study. Large vegetation on the mitral valve persists despite antibiotic therapy. When all views were considered it measured to be larger than Day 1: however, mitral regurgitation by color Doppler flow mapping appeared trivial. Day 6: patient taken to surgery. As much as possible of the vegetation was shaved off from the mitral valve which appeared to be otherwise structurally intact with no significant destruction. Post bypass study showed small residual vegetation but no significant mitral regurgitation. Day 13: large vegetation recurred with echolucencies consistent with aneurysm/abscess formation. Day 15: intraoperative and pre-bypass study. Rupture of aneurysm/abscess with significant mitral regurgitation by color Doppler.

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