hztrrnational Journal of Cardiology, 36 (1992) 373 0 1992 Elsevier Science Publishers B.V. All rights
CARD10
373 reserved
0167-5273/92/$05.00
01513
Letter to the Editor
Infective endocarditis Sir,
after balloon mitral dilatation
28 April 1992
We read with great interest the report of three cases of infective endocarditis of the mitral valve following percutaneous balloon dilatation by Kulkarni and co-workers [I]. We have encountered one such case in our experience of over 100 percutaneous mitral valve balloon dilatations from 1985 till date. A 14-yr-old boy underwent mitral valve balloon dilatation for severe mitral stenosis in January 1988. The valve area increased from 0.8 to 1.5 cm’ with moderate mitral regurgitation. He had to undergo emergency pericardiectomy the next day due to a slowly accumulating haemopericardium. The patient was readmitted 4 months later with fever of 1 month duration and an abscess over the back. There was no apparent increase in the degree of mitral regurgitation. Staphylococcus aureus was isolated from the blood cultures. Transthoracic echocardiography showed a large vegetation on the posterior mitral with mild stenosis and moderate insufficiency of the same valve. The patient was treated for 6 weeks with appropriate antibiotics and discharged in an afebrile state. Despite the prolonged nature of the procedure and extensive re-use of accessories and even balloons, we have not encountered any case of infective endocarditis
that can be directly attributed to the mitral valve balloon dilatation procedure itself. Our patient presumably developed infective endocarditis following bacteraemic spread from a cutaneous focus of infection. This is understandable since, despite successful dilatation, the deformed mitral valve would remain susceptible to bacteraemic seeding just like the native valve. In contrast to the experience of Kulkarni et al. the vegetation was clearly demonstrable by transthoracic echocardiography in our patient. We conclude that even after successful balloon dilatation, the diseased mitral valve remains susceptible to infective endocarditis and warrants continued efforts at vigorous treatment of infections as well as antibiotics prophylaxis for surgical procedures.
Department of Cardiology Cardiothoracic Centre All India Institute of Medical Sciences Ansari Nagar New Delhi-l 10 029
India
S. Shrivastava R. Agarwal
1 Kulkarni SM, Loya YS, Sharma S. Infective endocarditis following balloon dilatation of mitral valve. Int J Cardiol 1992;34: 103-105.
CARD10
373 reserved
0167-5273/92/$05.00
01513
Letter to the Editor
Infective endocarditis Sir,
after balloon mitral dilatation
28 April 1992
We read with great interest the report of three cases of infective endocarditis of the mitral valve following percutaneous balloon dilatation by Kulkarni and co-workers [I]. We have encountered one such case in our experience of over 100 percutaneous mitral valve balloon dilatations from 1985 till date. A 14-yr-old boy underwent mitral valve balloon dilatation for severe mitral stenosis in January 1988. The valve area increased from 0.8 to 1.5 cm’ with moderate mitral regurgitation. He had to undergo emergency pericardiectomy the next day due to a slowly accumulating haemopericardium. The patient was readmitted 4 months later with fever of 1 month duration and an abscess over the back. There was no apparent increase in the degree of mitral regurgitation. Staphylococcus aureus was isolated from the blood cultures. Transthoracic echocardiography showed a large vegetation on the posterior mitral with mild stenosis and moderate insufficiency of the same valve. The patient was treated for 6 weeks with appropriate antibiotics and discharged in an afebrile state. Despite the prolonged nature of the procedure and extensive re-use of accessories and even balloons, we have not encountered any case of infective endocarditis
that can be directly attributed to the mitral valve balloon dilatation procedure itself. Our patient presumably developed infective endocarditis following bacteraemic spread from a cutaneous focus of infection. This is understandable since, despite successful dilatation, the deformed mitral valve would remain susceptible to bacteraemic seeding just like the native valve. In contrast to the experience of Kulkarni et al. the vegetation was clearly demonstrable by transthoracic echocardiography in our patient. We conclude that even after successful balloon dilatation, the diseased mitral valve remains susceptible to infective endocarditis and warrants continued efforts at vigorous treatment of infections as well as antibiotics prophylaxis for surgical procedures.
Department of Cardiology Cardiothoracic Centre All India Institute of Medical Sciences Ansari Nagar New Delhi-l 10 029
India
S. Shrivastava R. Agarwal
1 Kulkarni SM, Loya YS, Sharma S. Infective endocarditis following balloon dilatation of mitral valve. Int J Cardiol 1992;34: 103-105.
