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J Cardiovasc Imaging
J Cardiovasc Imaging
Journal of Cardiovascular Imaging
2586-7210
2586-7296
BioMed Central London

6
10.1186/s44348-024-00006-5
Images
Images in cardiovascular disease: a rare case of perforated abscess of mitral valve after Infective Endocarditis (IE)
http://orcid.org/0000-0001-8231-7439
Niedźwiedzka Agata agata@niedzwiedzka.net

1
http://orcid.org/0000-0001-9032-9130
Pawlak Agnieszka 12
http://orcid.org/0000-0003-2670-4164
Suwalski Piotr 1
http://orcid.org/0000-0002-9041-3313
Gil Robert 12
1 grid.436113.2 Cardiology Department, National Medical Institute of the Ministry of the Interior and Administration, Wołoska Street 137, Warsaw, 02-507 Poland
2 grid.413454.3 0000 0001 1958 0162 Mossakowski Medical Research Centre, Polish Academy of Sciences, Warsaw, Poland
5 9 2024
5 9 2024
2024
32 281 4 2023
24 11 2023
© The Author(s) 2024
2024
https://creativecommons.org/licenses/by/4.0/ Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.
issue-copyright-statement© Korean Society of Echocardiography 2024
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pmcA 45-year-old patient presented to the emergency department reporting an episode of severe dyspnoea accompanied by chest discomfort that occurred at night. In addition, the patient periodically reported a feeling of a fast heartbeat, worsening of exercise tolerance and night sweats for several years. Medical history included an upper respiratory infection 3 weeks ago, uncontrolled hypertension, obesity, alcohol abuse and Streptococcus pneumoniae bacteraemia 5 years ago. Physical examination revealed loud holosystolic murmur at the apex. Electrocardiogram showed normal sinus rhythm and Q wave in II, III, aVF. Laboratory tests presented elevated troponin I (116.5 pg/mL) and N-terminal-pro-brain natriuretic peptide (591 pg/mL), inflammatory markers were within normal range. Transesophageal echocardiography revealed spontaneous echo contrast, bicuspid aortic valve, severe eccentric aortic regurgitation, mitral annular dilatation and a 15 × 15 mm capsule-like structure within the anterior leaflet of the mitral valve, possibly corresponding to a drained abscess or aneurysm. The capsule was perforated in several places (through which it was filling with a wave of regurgitation from the aortic valve) and was moving from the left atrium to the left ventricle through the anterior leaflet perforation causing a severe mitral regurgitation (Fig. 1A-C, Movies 1, 2, 3, 4, 5 and 6). The patient was qualified for cardiosurgical treatment where degeneration of aortic valve and capsule on the anterior leaflet of mitral valve were discovered (Fig. 1D). Both valves were replaced with biologic prosthesis. The blood culture test was positive for Staphylococcus capitis. Valve tissue culture test came back negative. S. capitis is a part of normal skin flora and it is responsible for < 10% of native valve endocarditis [1–3]. Given the lack of signs of current inflammation, based on medical knowledge we suspect the structure is related to the bacteraemia 5 years ago.Fig. 1 Transesophageal echocardiography revealed: A perforated abscess of the anterior mitral valve leaflet; B color turbulence due to wave of regurgitation from the aortic valve filling the perforated capsule. Three-dimensional echocardiographic imaging showed: C perforated capsule within the mitral valve; D intraoperative picture of the capsule

The authors confirm that written consent for submission and publication of this case report including images and associated text has been obtained from the patient in line with Committee on Publication Ethics guidance.

Supplementary Information

Additional file 1: Movie 1. On the top video we can see the movement of the perforated abscess of the anterior mitral valve leaflet—from the left atrium to the left ventricle through the anterior leaflet perforation. The bottom video shows perforated abscess filling with a wave of regurgitation from the aortic valve.

Additional file 2: Movie 2. Three-dimensional imaging presenting movement of the perforated abscess and the mitral valve.

Additional file 3: Movie 3. Three-dimensional imaging presenting movement of the perforated abscess in the left atrium.

Additional file 4: Movie 4. Transthoracic echocardiography- the parasternal shot axis view.

Additional file 5: Movie 5. Transthoracic echocardiography- the apical 4-chamber view: left ventricular ejection fraction 65%, left ventricular index 3.1 cm/m2. 

Additional file 6: Movie 6. Transthoracic echocardiography- the parasternal long axis view: bicuspid aortic valve (fusion of noncoronary and left coronary cusps), left coronary cusp prolapse, annulus 25 mm, sinotubular junction 27 mm.

Authors’ contributions

Conceptualization: Niedźwiedzka A, Pawlak A; Supervision: Suwalski P, Gil R; Writing—original draft: Niedźwiedzka A, Pawlak A; Writing—review & editing: Pawlak A, Suwalski P, Gil R. All the authors read and approved the final manuscript.

Declarations

Competing interests

The authors have no financial conflicts of interest.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
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