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The online version of this article contains two videos. The article and the video are available online (https://doi.org/10.1007/s12471-023-01790-3). The videos can be found in the article back matter as ‘Electronic Supplementary Material’.
A 73-year-old male presented to the emergency department with delirium and fever (39.2 °C) 1 week after receiving an intra-articular corticosteroid injection in his left glenohumeral joint to treat bursitis. Janeway lesions were noticed. The cardiologist was consulted and performed transthoracic and transoesophageal echocardiography, on which an impressive 8‑cm snake-like vegetation was seen on the mitral valve with minor regurgitation (Fig. 1a; see also Video 1 in Electronic Supplementary Material). Blood cultures grew Staphylococcus aureus. Based on the modified Duke criteria (two major criteria and three minor criteria), definite endocarditis was diagnosed [1]. Given the size and mobility of the vegetation, emergent cardiac surgery was performed, in which the vegetation was removed en bloc and the mitral valve was replaced (Fig. 1b; see also Video 2 in Electronic Supplementary Material). The patient died on the 17th postoperative day as a result of uncontrolled infection. Swift diagnosis and treatment in patients with (suspected) S. aureus endocarditis is crucial to improve outcomes.
Fig. 1
Image of the vegetation on transoesophageal echocardiography moving freely between the left atrium and left ventricle (a, Video 1). Intraoperative inspection of the mitral valve revealed that the vegetation originated from the subvalvular apparatus of the mitral valve and had damaged segment P1 of the posterior leaflet (b). The vegetation was removed en bloc (Video 2) and due to the damaged posterior leaflet, the mitral valve was replaced with a biological prosthesis. AMVL anterior mitral valve leaflet, PMVL posterior mitral valve leaflet, LA left atrium
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Conflict of interest
G.J. van Steenbergen, W. Tunnissen, N. Timmermans, P. Houthuizen, R. van den Broek and T. van Brakel declare that they have no competing interests.
Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.
Het Netherlands Heart Journal wordt uitgegeven in samenwerking met de Nederlandse Vereniging voor Cardiologie. Het tijdschrift is Engelstalig en wordt gratis beschikbaa ...
