Description

A 56-year-old man had undergone mitral valvuloplasty owing to a 3-year history of mitral insufficiency caused by chordae tendineae rupture. Prosthetic valve ring and artificial chordae tendineae are usually used in this case. The patient was referred to the hospital because of a continuous 2-month fever. At the time of admission, his blood pressure was 108/61 mm Hg, pulse was 98 bpm and regular, respiration rate was 18 breaths/min and body temperature was 38.8°C. On physical examination, Levine III/VI pansystolic murmur was found during auscultation of the ventricular apex. Exanthema and haemorrhagic lesions were absent. No abnormality was found on transthoracic echocardiography, but verrucous vegetations were identified in the posterior mitral leaflet of the left atrium on transoesophageal echocardiography (video 1). In addition, the abnormality was better observed using the surgeon's view of three-dimensional transoesophageal echocardiography (video 2).

A diagnosis of prosthetic valve endocarditis was established because Streptococcus bovis was detected in blood culture. The patient was treated with antimicrobial agents, and surgery was not performed.

Transoesophageal echocardiography is more useful than transthoracic echocardiograph1 for the diagnosis of infective endocarditis. In addition, three-dimensional transoesophageal echocardiography is visually more useful than two-dimensional transoesophageal echocardiography.