A Case of Infective Endocarditis Complicated with Multiple Myocotic Aneurysm and Mitral Valve Perforation

Mycotic aneurysm, uncommon complication of infective endocarditis (IE), develope more often in patients with subacute IE than acute IE. We report an unusual case of acute endocarditis complicated with multiple mycotic aneurysm and mitral valve perforation. 42 year old man who are referred for management of uncontrolled fever and dyspnea was diagnosed as acute mitral valve infective endocarditis caused by Staphylococcus aureus. He got complication of mycotic aneurysm on right femoral artery and mitral valve perforation with severe mitral regurgitation during favorable course of antibiotic treatment. Mycotic aneurysm was successfully treated with endovascular coil insertion and thrombin injection and mitral valve replacement was performed. On second day after operation, he died due to catastrophic intracranial hemorrhage which suggests another mycotic aneurysm rupture.

Anterior Mitral Leaflat Perforation in Patients with Bicuspid Aortic Valve Endocarditis

Mitral valve perforation is a rare cause of severe mitral regurgitation, which occurs most commonly as a secondary involvement of aortic valve endocarditis. The probable mechanisrns are direct extension of the infection from the aortic valve, infected aortic regurgitant jet striking the ventricular surfaces of the mitral-aortic intervalvular fibrosa(MAIVF) and the anterior mitral leaflet(AML). Early recognition of these subaortic complications in patients with aortic valve endocarditis is important because (1) these complications may produce severe mitral regurgitation and hemodynamic collapse, (2) the presence of severe mitral valve involvement may present as primary mitral valve disease, (3) these complications can be overlooked during aortic valve replacement, and (4) cause difficulty in valve replacement and high mortality. We report two cases of AML perforation observed in patients with bicuspid aortic valve endocarditis.