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Image in Cardiology
Native mitral valve endocarditis complicated with abscess and fistulas: Diagnosis by three-dimensional transesophageal echocardiography
Endocardite de válvula mitral nativa complicada por abcesso e fístulas: diagnóstico por ecocardiografía transesofágica 3D
Ana Gabaldón-Pérez
Corresponding author
anagabaldonperez@gmail.com

Corresponding author.
, Rafael De la Espriella, Hector Merenciano-Gonzalez, Enrique Santas, Francisco J. Chorro
Department of Cardiology, University Clinical Hospital of Valencia, Valencia, Spain
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    "titulo" => "Native mitral valve endocarditis complicated with abscess and fistulas&#58; Diagnosis by three-dimensional transesophageal echocardiography"
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        "titulo" => "Endocardite de v&#225;lvula mitral nativa complicada por abcesso e f&#237;stulas&#58; diagn&#243;stico por ecocardiograf&#237;a transesof&#225;gica 3D"
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          "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">&#40;A&#41; Transesophageal echocardiography &#40;TEE&#41; of the mitral valve at 55&#176;&#46; Note the abscess at the anterolateral commissure of the mitral valve &#40;arrow&#41;&#59; &#40;B&#41; surgical specimen consisting of the mitral valve abscess&#59; &#40;C&#41; TEE at 110&#176; with three-dimensional &#40;3D&#41; reconstruction of the mitral valve &#40;&#8216;surgical&#8217; view&#41;&#44; showing perforation of the anterior leaflet at the A1 level and the abscess &#40;asterisk&#41;&#59; &#40;D&#41; TEE at 110&#176; with 3D reconstruction of the mitral valve &#40;&#8216;surgical&#8217; view&#41;&#44; showing the other fistula directed toward the lateral wall of the left atrium and the abscess &#40;asterisk&#41;&#59; &#40;E&#41; TEE at 110&#176; with 3D reconstruction of the mitral valve view from the ventricular side&#46; Note the two fistulas in the same view&#59; &#40;F&#41; TEE at 125&#176; of the mitral valve with color Doppler showing the mitral regurgitation jets of both fistulas&#46;</p>"
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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">An 18-year-old male presented to the emergency department with persistent fever &#40;up to 39<span class="elsevierStyleHsp" style=""></span>&#176;C&#41; and progressive fatigue&#46; On admission&#44; physical examination revealed heart rate of 92 bpm&#44; temperature of 37&#46;4<span class="elsevierStyleHsp" style=""></span>&#176;C and a grade 4&#47;6 pansystolic murmur at the apex radiating to the left axillary area&#46; Complete blood count was normal&#44; but C-reactive protein was elevated at 207 mg&#47;l &#40;normal 0-5 mg&#47;l&#41;&#46; Transthoracic echocardiography &#40;TTE&#41; showed an echodense mass located at the mitral annulus associated with severe mitral regurgitation&#46; Three of four blood cultures were positive for <span class="elsevierStyleItalic">Haemophilus parainfluenzae</span>&#46; Transesophageal echocardiography &#40;TEE&#41; showed an annular abscess at the anterolateral commissure measuring 16 mm&#215;18 mm &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Figure 1</a>A and Video S1&#41;&#44; complicated by two fistulas&#58; one directed toward the lateral wall of the left atrium with three-dimensional &#40;3D&#41; effective regurgitant orifice &#40;ORE&#41; of 0&#46;28 cm<span class="elsevierStyleSup">2</span> &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Figure 1</a>C and E&#44; Video S2&#41; and another located more medially as a possible perforation of the anterior leaflet at the A1 level&#44; with 3D ORE of 0&#46;38 cm<span class="elsevierStyleSup">2</span> &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Figure 1</a>D and E&#44; Video S3&#41;&#44; which together were causing severe mitral regurgitation &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Figure 1</a>F&#41;&#46; These echocardiographic findings were confirmed at surgery&#44; in which resection of the anterolateral commissure &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Figure 1</a>B&#41; and commissurotomy were performed without intraoperarative complications and with an excellent postoperative course&#46; Control TTE showed minimal early systolic central regurgitation&#44; and no residual fistula was observed &#40;Videos S4-S6&#41;&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0010" class="elsevierStylePara elsevierViewall">This case highlights the usefulness of 3D-TEE for accurate assessment of the mitral valve apparatus&#44; as it enables cardiac surgeons to perform a comprehensive preoperative anatomical and functional assessment of this condition&#46;</p><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Conflicts of interest</span><p id="par0100" class="elsevierStylePara elsevierViewall">The authors have no conflicts of interest to declare&#46;</p></span></span>"
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ISSN: 08702551
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Revista Portuguesa de Cardiologia (English edition)
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