Multivalvular destruction as the primary presentation of aggressive infective endocarditis with subaortic valve membrane

Abstract

Multivalvular destruction may be a clinical manifestation of infective endocarditis (IE), which is a devastating infection of the heart either alone or superimposed with congenital subaortic membrane as in this case report. Here, we report a case of multivavular destruction with severe vegetation presented as a manifestation of infective endocarditis (IE) in a neglected case of 18-year-old male with previous rheumatic heart disease. Transesophageal echocardiography is an important imaging modality for diagnosis of superimposed aortic and heart lesions. Early necessary investigation and correct diagnosis is mandatory to prevent bad complications.

Keywords: Aortic regurgitation; Infective endocarditis; Mitral regurgitation; TEE; TTE.

Fig.1

Transthoracic echocardiography (TTE) images show a) M-mode revealing dilated left atrium, b) Tricuspid regurgitation with severe pulmonary hypertension, c) multiple masses on the aortic valve, the longest of 20 mm implanted like a membrane (arrow), d) Color flow mapping (CFM) revealing severe tricuspid regurgitation (TR) and mitral regurgitation (MR).

Fig.2

Trans esophageal echocardiography (TEE) show a) detracted aortic valve, b) the presence of sub aortic membrane (arrow), c) minimal pericardial effusion (arrow), d) severe mitral regurgitation (MR) with perforation of the anterior mitral valve leaflet.

Fig.3

Transthoracic echocardiography (TTE) post-operative images show a) aortic valve replacement, b) Color flow mapping (CFM) showing good functioning metallic aortic and mitral valves, c) apical view showing good positioning of the mitral valve, d) Color flow mapping (CFM) revealing remnant mild tricuspid regurgitation (TR).