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|Year : 1979 | Volume
| Issue : 4 | Page : 247-248
Infective endocarditis causing acute aortic regurgitation
Lilam S Shah, AS Vengsarkar
Department of Cardiology, Seth G. S. Medical College and K.E.M. Hospital, Parel, Bombay-400 012, India
Lilam S Shah
Department of Cardiology, Seth G. S. Medical College and K.E.M. Hospital, Parel, Bombay-400 012
Source of Support: None, Conflict of Interest: None
Interesting echocardiographic features in a case o f acute onset aortic regurgitation due to infective endocarditis of bicuspid aortic valve are reported. Early closure of mitral valve (ECMV) recognised by echocardiography confirmed the clinical diagnosis of acute inset aortic regurgitation. Aortic root echocardiogram showed ec-centric diastolic closure line of bicuspid aortic leaflets and multiple echoes on aortic leaflets due to bacterial vegetations.
|How to cite this article:|
Shah LS, Vengsarkar A S. Infective endocarditis causing acute aortic regurgitation. J Postgrad Med 1979;25:247-8
| :: Introduction|| |
In 1886, Austin Flint  first postulated the occurrance of early closure of mitral valve in severe aortic insufficiency. In 1971, Pridie  made the observation of echocardiographic premature closure of mitral valve in severe aortic insufficiency. Early closure of mitral valve in acute aortic regurgitation suggested a severe haemodynamic compromise. This was observed in our case of acute onset severe aortic regurgitation due to infective endocarditis.
| :: Case report|| |
A 22 year old male was admitted to the hospital with the complaints of fever, breathlessness, palpitations and clubbing of nails of one month's duration; he had dark coloured urine for 15 days. The patient had cl. III (MYNA) effort intolerance, exertional palpitations and chest pain.
Clinical examination revealed B. P. of 130/ 90 mm Hg., clubbing of nails, dancing carotids, water hammer pulse and pistol shot II sound over femoral arteries. Cardiovascular system examination showed visible suprasternal pulsations and left ventricular hypertrophy. In apical area there was a loud murmur (due to premature closure of mitral valve). There was no OS or presystolic murmur, but a functional diastolic rumble of Austin Flint; S 3 was heard. In aortic area there was early diastolic murmur of Gr. 3/4 due to aortic regurgitation and 3/6 ejection systolic murmur of aortic stenosis. The patient had raised JVP and hepatomegaly; spleen was palpable. From the h/o acute onset of symptoms and the clinical findings a diagnosis of acute aortic regurgitation due to infective endocarditis and congestive heart failure was made.
Investigations revealed raised ESR, microscopic haematuria and positive blood culture. X-ray and ECG revealed left ventricular dilatation. His echocardiogram showed premature closure of mitral valve much before the inscription of QRS, and high frequency oscillations on AML. (See [Figure 1] on page 248B). The EF slope and PML motion were normal. Left ventricle was dilated; LVIDd was 6.5 cm. and LVIDs was 5.5 cm.
Aortic root echogram (See [Figure 2] on page 246B) showed aortic root diameter of 3.5 cm and eccentric diastolic closure line Anterior and posterior aortic wall echoes were thick and echoes from bacterial vegetations were seen on aortic leaflets. Left atrial size was 2 cm. Aorta/Left atrial ratio was 1.7. This revealed that the patient had probably congenital bicuspid aortic valve on which he developed infective endocarditis, acute aortic regurgitation and congestive cardiac failure.
| :: Discussion|| |
Early closure of mitral valve (ECMV) is a specific feature of the acute onset severe aortic regurgitation. Austin Flint murmur appears to correlate well with the type of early closure of mitral valve (A or B). , Our case showed type B early closure of mitral valve.. The factors affecting the early closure of mitral valve are heart rate, associated mitral stenosis, and amyl nitrite.  Early closure of mitral valve is due to extreme elevation of left ventricular end diastolic pressure due to reflux of large volume of blood in a relatively non-compliant ventricle. Patients with early closure of mitral valve demonstrate severe haemodynamic compromise and are candidates for valve replacement .  Our case showed early closure of mitral valve suggesting severe left ventricular functional impairment; he died before the valve replacement could be offered. The echocardiographic detection of vegetation on valves due to infective endocarditis has already been described ,,
| :: References|| |
|1.||Botvinick, E. H., Schiller, N. B., Wickramasekasan, R., Klausner, S. C. and Gertz, E.: chocardiographic demonstration of early mitral valve closure in severe aortic insufficiency. Its clinical implication. Circulation, 51: 836-847, 1975. |
|2.||Dillon, J. C., Feigenbaum, H., Konecke, L. L., Davis, R. H. and Chang, S.: Echocardiographic manifestations of valvular vegetations. Amer. Heart J., 86: 698-704, 1973. |
|3.||Flint, A.: On cardiac murmurs. Amer. J. Med. Sci., 91: 27, 1886 as Quoted by Botvinick et al, 1975.1 |
|4.||Mann, T., McLaurin, L., Grossman, W. and Craige, E.: Assessing the haemodynamic sensity of acute aortic regurgitation due to infective endocarditis. New Eng. J. Med., 293: 108-113, 1975. |
|5.||Pridle, R. B., Benham, R. and Oakley, C. M.: Echocardiography of the mitral valve in aortic valve disease. Brit. Heart J . , 33: 296-304, 1971. |
|6.||Roy, P., Tajik, A. J., Guilian, E. R. et al.: Spectrum of echocardiographic findings in bacterial endocarditis. Circulation. 53: 474-482, 1976. |
|7.||Wann, L. S., Dillon, J. C., Weyman, A. E., and Feigenbaum, H.: Echocardiography in bacterial endocarditis. New Eng. J. Med., 295: 135-139, 1976. |
[Figure 1], [Figure 2]