A Case of Mitral Regurgitation due to Windsock Deformity with Perforations of the Anterior Mitral Leaflet-a Late Complication of Endocarditis

A valvular perforation is a well-known, and common, complication of infective endocarditis that may adversely affect the clinical outcome. However, a 'windsock' deformity of the mitral valve, as a delayed presentation of infective endocarditis, affecting the mitral valve alone, is very rare. A 42-year-old man, who underwent a mitral valvuloplasty and annuloplasty six years previously, suddenly developed pulmonary edema. He had also had a previous history of infective endocarditis, dating back three years. A transthoracic echocardiogram revealed a 'windsock' deformity of the anterior mitral leaflet (AML), resulting in an acute severe mitral regurgitation. During the operation, the AML was found to have been damaged by the previous endocarditis, resulting in an aneurysmal change of the central scallop, and a rupture of the roof. A mitral valve replacement was successfully performed, and the patient recovered uneventfully. Here, we report a rare case of a 'windsock' deformity of the mitral valve, with two perforations as a delayed complication of a healed infective endocarditis.

Coronary Arteriovenous Fistula: Percutaneous Transcatheter Coil Embolization

BACKGROUND: Coronary arteriovenous(AV) fistula is a rare congenital disease, and seldom produce symptoms during childhood. However late complications can occur including congestive heart failure, myocardial ischemia, and bacterial endocarditis. Therefore surgical repair is recommended even if the patients are asymptomatic. In these days many investigators are interested in transcatheter embolization because of high procedural success rate without risks and morbidity associated with cardiac surgery. METHODS: Five patients(4 females and 1 male) of coronary AV fistula were treated with transcatheter coil embolization. All had symptom of chest pain. In coronary angiograms fistulous tracts were originated from left anterior descending artery(LAD) and drained to main pulmonary artery(MPA) in 4 cases. The other case had abnormal vessel from left circumflex artery(LCX) to bronchial artery. Transcatherter coil embolization were done with Judkins left guiding catheter, 018 inch Tracker or 3F Microferret catheter, and 018 inch coils. RESULTS: The fistula tracts were completely occluded in 3 cases after coil emboilzation. In 2 cases with multiple fistular vessels, major fistula were occluded, but minor vessels remained. There were no procedure related complications. CONCLUSION: Transcatheter coil embolization may be an effective treatment modality in coronary AV fistula with excellent result and minimal complications.