Case 4

A 59-year-old male with a fever of unknown origin was referred for a transthoracic echocardiography (TTE). Before the presentation, the patient took amoxicillin for several days. The patient has a history of aortic and mitral valve replacement with mechanical prostheses for rheumatic heart disease 10 years ago.

The TTE revealed: left ventricle ejection fraction of 25%, end-diastolic left ventricle volume of 250 ml, aortic valve prosthesis maximal velocity of 2.4 m/s, aortic valve prosthesis mean gradient of 13 mmHg, mitral valve prosthesis maximal velocity of 1.7 m/s, mitral valve prosthesis mean gradient of 4 mm Hg. Mobility of the valve prostheses leaflets was normal.
Transesophageal echocardiography (TEE) demonstrated small mobile structures on the atrial site of mitral valve prosthesis and mild paraprosthetic mitral regurgitation. Blood cultures were triple negative. Two weeks later, a TEE was repeated due to patient deterioration. The patient suffered from progressive dyspnea, hypotension and fever. Repetitive TEE revealed mitral valve prosthesis mean gradient of 6 mmHg.

Case Studies in Infective Endocarditis an Update, part 2

Case 2