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Heart 2000;83:261; doi:10.1136/heart.83.3.261
Copyright © 2000 BMJ Publishing Group Ltd & British Cardiovascular Society
Heart 2000;83:261 ( March )

Images in cardiology

Perivalvar abscess of the mitral valve annulus with perforation owing to infective endocarditis

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A 74 year old man presented with unstable angina and moderate aortic stenosis. He had an aortic valve replacement (Carpentier Edwards 19 mm porcine valve) and three reversed saphenous vein grafts to the first obtuse marginal, left anterior descending, and right coronary arteries. He was referred back three months later with a two week history of tiredness, night sweats, and weight loss of 5 kg. There was no history of any dental work or other surgical procedures after his cardiac operation. His temperature was 38.2°C and there were no peripheral stigmata of infective endocarditis.

Cardiac examination revealed a pansystolic murmur in the mitral area with a soft ejection murmur in the aortic area. Laboratory investigations showed microscopic haematuria, haemoglobin 97 g/l, white cell count 14 × 109/l, and an erythrocyte sedimentation rate of 83 mm in the first hour.

ECG showed second degree heart block (Wenckebach) with left bundle branch block pattern that was not present . . . [Full text of this article]
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