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Case Reports in Cardiology
Volume 2015, Article ID 790213, 3 pages
http://dx.doi.org/10.1155/2015/790213
Case Report

Cardiac Tamponade following Mitral Valve Replacement for Active Infective Endocarditis with Ring Abscess

Department of Cardiology, Cardiovascular and Thoracic Institute, University of Southern California, Los Angeles, CA 90033, USA

Received 7 September 2014; Revised 22 December 2014; Accepted 24 December 2014

Academic Editor: Mohammad R. Movahed

Copyright © 2015 R. Ranjan and T. Lawrence. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Periannular extension and abscess formation are rare but deadly complications of infective endocarditis (IE) with high mortality. Multimodality cardiac imaging, invasive and noninvasive, is needed to accurately define the extent of the disease. Debridement, reconstruction, and valve replacement, often performed in an emergent setting, remain the treatment of choice. Here we present a case of severe IE in a 29-year-old intravenous drug user who after undergoing debridement of the abscess, annular reconstruction, and mitral valve replacement (MVR) presented with recurrence of shortness of breath and pedal edema. Transthoracic echocardiogram (TTE) showed a  cm cavity, posterior to and communicating with the left ventricle through a 3 cm wide fistulous opening, in proximity of the reconstructed mitral annulus. The patient underwent a redo MVR with patch closure of the fistulous opening, with good clinical outcome. This case highlights the classic TTE findings and the necessity for close follow-up in the perioperative period in patients undergoing surgery for periannular extension of infection. A cardiac magnetic resonance imaging can be considered, preoperatively, in such cases to identify the extent of myocardial involvement and surgical planning.