Multimodality Imaging of the Mitral Valve: Morphology, Function, and Disease.

The mitral valve apparatus is one of the key structures of the heart with complex anatomy and function. The prevalence of mitral valve disease is associated with age: elderly people are affected more frequently. There are multiple inherited and acquired conditions; tumors may also involve the mitral valve. Stenosis and regurgitation are the main manifestations of valvular disease. Echocardiography, computed tomography, and cardiovascular magnetic resonance imaging are widely applied techniques for anatomical and functional evaluation of the mitral valve. Each of the modalities has unique applications and limitations, therefore assessment of mitral valve disease requires a multimodality imaging approach. In this pictorial essay, we review normal anatomy and physiology of the mitral valve as well as multimodality imaging manifestations of mitral valve disease.

Multimodality imaging in a late septic infection of aortic graft.

A 70-year-old diabetic female patient presented with fatigue, headaches, hallucinations and shivers following a history of sinusitis and ophthalmitis. She had an aortic surgery performed 7 years ago for a stenotic and regurgitant aortic valve with aneurysm of the ascending aorta. Work-up brain MRI revealed septic-embolic encephalitis. Multimodality cardiovascular imaging showed abnormal anterior wall of the ascending aortic graft with vegetation extending into the lumen. Blood culture was only positive for Aggregatibacter actinomycetemcomitans, an uncommon cause of infective endocarditis. During aortic surgery, the intraluminal vegetation with suppurated perigraft tissue was confirmed.

[Clinical forms of infective endocarditis in Kaunas University of Medicine Hospital in 2002-2005]. / Infekcinio endokardito klinikines formos Kauno medicinos universiteto klinikose 2002-2005 m.

OBJECTIVES: To determine the incidence and distribution of clinical forms of infective endocarditis and to compare these data with data of 1983-1993. MATERIAL AND METHODS: A retrospective analysis of clinical data of 116 patients with infective endocarditis treated in Kaunas University of Medicine Hospital in 2002-2005 was performed. The data were compared with analogical data of 1983-1993. RESULTS: During 2002-2005, 55 (47.4%) patients presented with classic symptoms of infective endocarditis. In 61 cases, atypical clinical manifestations were observed: 19 patients presented with heart failure symptoms, 14 patients with embolic symptoms, 9 with pulmonary manifestations, and 5 patients with septic manifestations. There were three cases of nephritic form, three cases of rheumatic form, three cases of meningoencephalitic form, and two cases of ophthalmic form. In three cases, pacemaker endocarditis was seen. During the period of 1983-1993, 15 patients with infective endocarditis were treated annually in Kaunas University of Medicine Hospital; in 2002-2005, this number increased to 29 cases per year. More cases of embolic and pulmonic clinical forms of infective endocarditis were diagnosed as compared to the data of 1983-1993 (P<0.05). There were more cases of primary endocarditis in 2002-2005 than in 1983-1993 (36.2% and 23.8%, respectively, P<0.05). CONCLUSIONS: Typically, infective endocarditis manifests as classical symptoms, but in more than half of cases, atypical forms were observed, the most common of which were heart failure form and embolic form. Primary infective endocarditis was detected more frequently.

[Influence of surgery on survival in infective endocarditis]. / Infekcinio endokardito chirurginio gydymo itaka ligoniu isgyvenamumui.

An impact of surgery for infective endocarditis on survival and heart failure has been analyzed. A total of 131 patients with IE have been observed during 1999-2001. Eighty seven of them were male and 44 female, mean age - 50+/-16 years. Sixty three (48.1%) patients underwent surgery, remaining 68 (51.9%) were treated conservatively. The surgical patients had signs of remarkably worse heart failure (p=0.0001), higher grade aortic (p=0.0001) and mitral (p=0.001) valve regurgitation. Surgery resulted in significant improvement of heart failure (p=0.01). Hospital mortality was 25.2% and did not differ between the groups. Elimination of the influence of complications revealed reduced hospital mortality of all patients by 9.9% and mortality of NYHA III-IV patients by 23.9% (p=0.02) as a result of surgery.

[Streptococcus bovis endocarditis - predictor of colonic carcinoma? ]. / Streptococcus bovis sukeltas endokarditas - zarnyno vezio rodmuo?

The association of Streptococcus bovis endocarditis with colonic neoplasia is classically described and exceeds 50 percent. The prevalence of Streptococcus bovis in fecal cultures from patients with carcinoma of the colon is significantly increased (56%) as compared to that in controls (10%) and also in patients with inflammatory bowel disease (28%). Streptococcus bovis endocarditis is relatively benign, but it stresses the frequency of the associated colonic carcinoma, requiring colonoscopy and making the treatment of the high-risk lesion mandatory. The article covers a literature review and a case report.

[Timing of surgery in infective endocarditis: impact on the outcome and recurrence]. / Infekcinis endokarditas: operacijos laiko rysys su hospitaline mirtimi ir ligos atkryciu.

Timing of surgery in infective endocarditis remains a challenge in the face of potential drug toxicity on one hand and recurrence of endocarditis on the other. The aim of the study was analysis of risk factors for hospital mortality and recurrent endocarditis. A total of 131 patients with infective endocarditis have been observed during 1999-2001. Eighty seven of them were male and 44 female with mean age of 50+/-16 years. Sixty three (48.1%) patients underwent surgery, remaining 68 (51.9%) were treated conservatively. Hospital mortality was 25.2%. Postoperative perivalvular leak was associated with culture negative endocarditis (p=0.09) as well as with positive valve culture (p=0.04). Recurrence was related to positive valve culture (p=0.08) and embolism (p=0.02). Increased risk of death was associated with neurologic, embolic, renal complications, myocardial abscess, NYHA IV f.cl. and extracardial surgery. According to the data obtained, optimal surgery time in the group appeared to be between 17 and 45 days after the diagnosis of infective endocarditis has been made (p=0.049).

[Effect of blood and valve cultures on complication rate and outcome of infective endocarditis (analysis of data of patients treated at Kaunas district hospitals, 1999-2001)]. / Infekcinio endokardito komplikacijos ir ligos baigtys esant skirtingiems kraujo ir sirdies voztuvu audinio mikrobiologiniu tyrimu duomenims (ligoniu, gydytu Kauno apskrities ligoninese 1999-2001 m., duomenu analize).

The objective of the study was to determine the current epidemiology of infective endocarditis (IE) and to evaluate correlation of blood and valve cultures with complication rates of the disease. During 1999-2001 138 patients, 91 (65.9%) males and 47 (34.1%) females with mean age of 50 +/- 16, were observed. The incidence of IE makes 0.0042% per year in Kaunas district, in-hospital mortality rate was 24.6%. Forty five patients had positive blood culture, 54.8%--negative blood cultures, 16.9% of valve tissue cultures were positive. Patients with positive blood culture had higher incidence of acute IE, vascular phenomena, peripheral abscess and toxic encephalopathy. Culture negative endocarditis presented itself with worse left ventricular function, more frequent immunologic phenomena, myocarditis, glomerulonephritis, cardiac operation and perivalvular leak. Positive valve culture was associated with more frequent perivalvular leak. Mortality rate did not differ in groups.