Mitral Stenosis and Mitral Incompetence due to Libman-Sacks Endocarditis with Mitral Valve Replacement

Abstract: A patient is described with recurrent severe left heart failure induced by combined mitral stenosis and incompetence secondary to Libman-Sacks endocarditis. Marked improvement followed mitral valve replacement with a 29 mm St. Jude Medical Bi-Leaflet prosthesis. There was no evidence of rheumatic valve disease either macroscopically at operation or on histological examination of the excised valve .     

A Case of Life‐threatening Staphylococcus aureus Endocarditis Involving Percutaneous Transcatheter Prosthetic Pulmonary Valve

While right ventricle to pulmonary artery homograft is the surgical procedure of choice for relieving right ventricle outflow tract obstruction; it is limited by the need for multiple surgical replacements owing to progressive conduit obstruction, valve dysfunction, or patient growth. Since January 2010, percutaneous transcatheter placement of prosthetic pulmonary valve (Melody valve) has emerged as an attractive alternative to surgical replacement of dysfunctional right ventricle to pulmonary artery homograft in the United States. We report a case of 19‐year‐old girl born with truncus arteriosus who underwent transcatheter placement of prosthetic pulmonary valve due to homograft insufficiency. She presented after 4 months with a febrile episode and was found to have Staphylococcus aureus endocarditis of her prosthetic valve. The infection caused multi‐organ dysfunction despite bacteriological clearance and led to severe dysfunction of the valve which ultimately required surgical removal. The case highlights a rare but serious complication of percutaneous prosthetic pulmonary valves.     

Mitral Valve Surgery for Severe Mitral Regurgitation and Dilated Cardiomyopathy—A Bridge to Transplant: Case Report and a Review of Literature

We report a child with myocardial necrosis, dilated cardiomyopathy, and severe mitral valve (MV) regurgitation following neonatal enteroviral myocarditis. He underwent MV annuloplasty at 18 months and MV replacement at 3 years of age. He remains asymptomatic on medical therapy at 8 years of age. Mitral valve surgery may stabilize the evolution of dilated cardiomyopathy and delay the ultimate need for heart transplant.     

Criteria for Mitral Regurgitation Classification were inadequate for Dilated Cardiomyopathy

Background

Mitral regurgitation (MR) is common in patients with dilated cardiomyopathy (DCM). It is unknown whether the criteria for MR classification are inadequate for patients with DCM.

Objective

We aimed to evaluate the agreement among the four most common echocardiographic methods for MR classification.

Methods

Ninety patients with DCM were included. Functional MR was classified using four echocardiographic methods: color flow jet area (JA), vena contracta (VC), effective regurgitant orifice area (ERO) and regurgitant volume (RV). MR was classified as mild, moderate or important according to the American Society of Echocardiography criteria and by dividing the values into terciles. The Kappa test was used to evaluate whether the methods agreed, and the Pearson correlation coefficient was used to evaluate the correlation between the absolute values of each method.

Results

MR classification according to each method was as follows: JA: 26 mild, 44 moderate, 20 important; VC: 12 mild, 72 moderate, 6 important; ERO: 70 mild, 15 moderate, 5 important; RV: 70 mild, 16 moderate, 4 important. The agreement was poor among methods (kappa = 0.11; p < 0.001). It was observed a strong correlation between the absolute values of each method, ranging from 0.70 to 0.95 (p < 0.01) and the agreement was higher when values were divided into terciles (kappa = 0.44; p < 0.01)

Conclusion

The use of conventional echocardiographic criteria for MR classification seems inadequate in patients with DCM. It is necessary to establish new cutoff values for MR classification in these patients.     

单纯先天性二尖瓣关闭不全临床分析

本文对北京安贞医院1984年4月至1994年12月收治的24例18岁以下单纯先天性二尖瓣关闭不全患儿进行了回顾性总结，临床表现主要为来自肺静脉高压和低心排量所致活动后呼吸困难、疲乏。生长发育不受影响。心电图、超声心动图、心脏X线检查主要为左心负荷容量增加及左房左室扩大。手术方法首选二尖瓣成形术，手术预后与术前心功能相关。     

Double Prosthetic Valve Endocarditis Caused by Streptococcus pneumoniae

Summary Infective endocarditis (IE) caused by Streptococcus pneumoniae is a rare disease. Only eight cases of pneumococcal prosthetic valve endocarditis have been described in the literature. In this report we describe the first case of pneumococcal endocarditis involving two prosthetic heart valves. The patient had pneumonia as the probable portal of entry but no predisposing conditions for invasive pneumococcal disease. Our case also illustrates the importance of transesophageal echocardiography (TEE) for the early diagnosis of IE and a timely decision for cardiac surgery. Received: August 20, 1999 · Revision accepted: November 17, 1999     

Angiotensin-converting Enzyme Inhibitors in Pediatric Patients with Mitral Valve Regurgitation—Case-control Study and Review of the Literature

Objectives. To investigate the effectiveness of chronic administration of angiotensin-converting enzyme inhibitors in pediatric patients with mitral valve regurgitation. Design, Setting, Patients, Interventions. This was a case-control study of all echocardiograms of patients with moderate-to-severe mitral valve regurgitation, who underwent chronic administration of angiotensin-converting enzyme inhibitors between January 1990 and December 2006 at a single center. Outcome Measures. Echocardiographic parameters (left ventricular end-diastolic diameter, left ventricular posterior wall diameter, interventricular septum diameter, left atrium to aortic root diameter ratio, grade of mitral valve regurgitation, shortening fraction) were analyzed before and during therapy with angiotensin-converting enzyme inhibitors in 12 patients and compared with 12 patients without medications after one month and one year. Results. Twenty-four consecutive pediatric patients (median age of 7 years with a range 1 month–16 years) with moderate-to-severe mitral valve regurgitation were included. Data are given as standard deviation scores (z-scores) derived from body-surface-adjusted normal values. During angiotensin-converting enzyme inhibition left ventricular end-diastolic diameter decreased from mean z-score 2.04 to 1.66 (after 1 month) and to 1.73 (after 1 year), while left ventricular posterior wall diameter decreased from 0.25 to 0.12 (after 1 year), respectively. Shortening fraction, interventricular septum diameter, grade of mitral valve regurgitation, and left atrium to aortic root diameter ratio remained stable. Conclusions. In this case-control study of patients with moderate-to-severe mitral valve regurgitation effectiveness of angiotensin-converting enzyme inhibition on left ventricular dimensions and function after 1 month and 1 year is limited. Reviewing the literature, the lack of long-term follow-up studies with large patient cohorts and controversial study-results in adults require a prospective long-term multicenter follow-up study in pediatric patients.