IMAGING IN CARDIOLOGY
Aortic valve perforation as a complication of
acute infective endocarditis G. Dewyanti, H.M.M. Al Hashimi, A.J.J.
van
Es, P.M.J. Verhorst, G.P. Molhoek
Figure 1. Transoesophageal echocardiogram. A. Long-axis view demonstrating a deformed aortic valve leaflet. B. Lonyg-axis view demonstrating a perforation of the aortic valve. C Long-axis view colour Doppler demonstrating an aortic valve regurgitation. D. Sbort-axis view demonstrating a perforation of the right coronary cusp of the aortic valve
A 39-year-old man presented to our cardiac carc unit xvith a fever of three weeks' duration. His past medical historv revealed a car accident in 1990 causing partial rupture of the aortic valve (left coronary cusp) and left carotid artery, which were surgically repaired. A mild aortic regurgitation persisted after the
operationi. Pihysical examination showed a hacmodynamically stable patient with a body temperature of 39°C. On G. Dewyanti A.J.J. van Es P.M.J. Verhorst G.P. Molhoek Department of Cardiology, Twente Medical Centre, Enschede H.M.M. Al Hashimi Department of Cardiology, St Radboud University Medical Centre, Nijmegen
Correspondence to: H.M.M. Al Hashimi Department of Cardiology, St Radboud University Medical Centre, Geert Grootplein 10, PC 6500 HB Nijmegen E-mail: [email protected]
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Netherlanids Heart Jounial, Volumiie 13, Number 11, November 2005
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IMAGING IN CARDIOLOGY
examination ofthe heart, a grade 3/6 diastolic rumbling murmur was heard at the left sternal border. There were no signs of heart failure. The chest X-ray showed no abnormalities. Increased inflammatory parameters were found in the laboratory findings. The blood cultures were positive for Staphylococcus aureus. Taking his medical history into consideration in combination with the physical examination, a bacterial endocarditis was highly suspected. Therefore, a transthoracic echocardiogram was performed, in which only a mild aortic valve regurgitation was detected. In the meantime intravenous flucloxacillin and gentamycin were started. A few days later a transoesophageal echocardiogram was performed which demonstrated a perforation ofthe nght coronary cusp ofthe aortic valve with grade 3 aortic valve regurgitation (figures lA to D). To calculate the ejection fraction ofthe regurgitation jet, an MRI was performed which also revealed a dilated
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Netherlands Heart Joumnal, Volume 13, Number 11, November 2005
left ventricle with a severe aortic valve regurgitation. After six weeks of treatment with intravenous antibiotics, he underwent a successfiul and uneventful aortic valve replacement. v
In this section a remarkable 'image' is presented and a short comment is given. We invite you to send in images (in triplicate) with a short comment (one to two pages at the most) to Bohn Stafleu van Loghum, PO Box 246, 3990 GA Houten, e-mail: [email protected]. 'Moving images' are also welcomed and (after acceptance) will be published as aWeb Site Feature and shown on our website: www.cardiologie.nl
Thissection is edited by M.J.M. Cramer andjj. Bax.
427
Aortic valve perforation as a complication of
acute infective endocarditis G. Dewyanti, H.M.M. Al Hashimi, A.J.J.
van
Es, P.M.J. Verhorst, G.P. Molhoek
Figure 1. Transoesophageal echocardiogram. A. Long-axis view demonstrating a deformed aortic valve leaflet. B. Lonyg-axis view demonstrating a perforation of the aortic valve. C Long-axis view colour Doppler demonstrating an aortic valve regurgitation. D. Sbort-axis view demonstrating a perforation of the right coronary cusp of the aortic valve
A 39-year-old man presented to our cardiac carc unit xvith a fever of three weeks' duration. His past medical historv revealed a car accident in 1990 causing partial rupture of the aortic valve (left coronary cusp) and left carotid artery, which were surgically repaired. A mild aortic regurgitation persisted after the
operationi. Pihysical examination showed a hacmodynamically stable patient with a body temperature of 39°C. On G. Dewyanti A.J.J. van Es P.M.J. Verhorst G.P. Molhoek Department of Cardiology, Twente Medical Centre, Enschede H.M.M. Al Hashimi Department of Cardiology, St Radboud University Medical Centre, Nijmegen
Correspondence to: H.M.M. Al Hashimi Department of Cardiology, St Radboud University Medical Centre, Geert Grootplein 10, PC 6500 HB Nijmegen E-mail: [email protected]
426
Netherlanids Heart Jounial, Volumiie 13, Number 11, November 2005
qpc
IMAGING IN CARDIOLOGY
examination ofthe heart, a grade 3/6 diastolic rumbling murmur was heard at the left sternal border. There were no signs of heart failure. The chest X-ray showed no abnormalities. Increased inflammatory parameters were found in the laboratory findings. The blood cultures were positive for Staphylococcus aureus. Taking his medical history into consideration in combination with the physical examination, a bacterial endocarditis was highly suspected. Therefore, a transthoracic echocardiogram was performed, in which only a mild aortic valve regurgitation was detected. In the meantime intravenous flucloxacillin and gentamycin were started. A few days later a transoesophageal echocardiogram was performed which demonstrated a perforation ofthe nght coronary cusp ofthe aortic valve with grade 3 aortic valve regurgitation (figures lA to D). To calculate the ejection fraction ofthe regurgitation jet, an MRI was performed which also revealed a dilated
llPC
Netherlands Heart Joumnal, Volume 13, Number 11, November 2005
left ventricle with a severe aortic valve regurgitation. After six weeks of treatment with intravenous antibiotics, he underwent a successfiul and uneventful aortic valve replacement. v
In this section a remarkable 'image' is presented and a short comment is given. We invite you to send in images (in triplicate) with a short comment (one to two pages at the most) to Bohn Stafleu van Loghum, PO Box 246, 3990 GA Houten, e-mail: [email protected]. 'Moving images' are also welcomed and (after acceptance) will be published as aWeb Site Feature and shown on our website: www.cardiologie.nl
Thissection is edited by M.J.M. Cramer andjj. Bax.
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