A case of accessory mitral valve leaflet associated with solitary mitral cleft.

Accessory mitral valve leaflet is a rare congenital anomaly. More than half of the cases show other congenital cardiac defects and almost all of the cases show subaortic obstruction. We report a case of an accessory mitral valve tissue without outflow obstruction associated with mitral cleft of the posterior mitral leaflet. To our knowledge, this is the first reported case of the combination of these two congenital anomalies.     

A rare case of mitral valve dissection and aortic‐left ventricular tunnel associated with possible autoimmune vasculitis

We report a very rare case of mitral valve dissection and aortic‐left ventricular tunnel caused by possible autoimmune vasculitis. We suspected Behcet's disease in this patient. There was no obvious clinical evidence of infective endocarditis. Echocardiography is the diagnostic tool of choice to recognize valvular dysfunction, related pathology, and possible complications. The patient may require immunosuppressive therapy due to the high likelihood of recurrence in the perioperation period.     

A rare case of Lactobacillus acidophilus presenting as mitral valve bacterial endocarditis

Lactobacillus acidophilus is a gram-positive rod that is a commensal of human mucosal tissues. They are usually considered nonpathogenic flora of the mouth, gut, and female genital tract. Lactobacillus is a rare cause of endocarditis with less than 50 cases reported in the world literature to date. We report the case of a 63-year-old woman who developed native mitral valve endocarditis secondary to L. acidophilus, and examine the literature regarding this rare entity.     

A case of bilateral coronary artery--pulmonary artery fistulas associated with mitral valve stenosis

A case was reported of bilateral coronary artery-pulmonary artery fistulas associated with mitral valve stenosis. A thirty seven year old female was admitted with the complaint of exertional dyspnea and palpitation, which had lasted for the 3 years previous to her admission to our hospital. Electrocardiogram showed sinus bradycardia and no ST-T changes, but exercise ECG showed significant ST depression after 6 min of exercise. The DDR (9 mm/sec) and mitral valve area (0.61 cm2) were shown by UCG examination to have decreased, and the pressure at half time (360 msec) was shown by Doppler UCG to be prolonged. On cardiac catheterization, coronary arteriography showed fistula from RCA to PA, and fistula from LCA to PA, but no occlusive lesions were demonstrated. P/S blood flow ratio was 1.09, and O2 saturation was stepped up 3% in PA. She was operated on and given open mitral commissurotomy and closure of the fistula opening, via the PA. After surgical repair, no abnormality was found by exercise ECG, and no fistulas were shown on coronary arteriography.     

Transient severe mitral regurgitation after mitral valve repair is associated with a poor clinical outcome: a small case series

Background: During mitral valve repair, patients with transesophageal echo‐detected immediate postoperative systolic anterior motion of the mitral valve (SAM) and mitral regurgitation (MR) are successfully medically managed. They have been shown to do well in a short‐term follow‐up. However, the long‐term outcome has not been investigated. The objective of this project was to investigate the long‐term outcome of these patients. Methods: This is an observational, retrospective study of 385 patients who underwent MVR. All cases of SAM and MR in this report were successfully medically managed with conservative therapy preventing the need for immediate surgical reintervention. Patients were divided into two groups based on the severity of MR. Group I had grade ≤ 2 + MR (     

Cellular characterization of the gouty tophus: A quantitative analysis

Objective

To characterize the cellular architecture of the tophus and to determine the presence of cytokines implicated in the initiation and resolution of gouty inflammation.

Methods

Sixteen fixed, paraffin‐embedded, uninfected tophus samples were surgically obtained from 12 patients with microscopically proven gout and were analyzed by quantitative immunohistochemistry. The number of cells present in the corona and fibrovascular zones of the tophus was analyzed by Genmod mixed models analysis.

Results

Numerous CD68+ mononucleated and multinucleated cells were present within the corona zone. Mast cells were identified in all tophus samples and at similar densities throughout the corona and fibrovascular zones. In contrast, neutrophils were rarely observed. Plasma cells were present in very high numbers within the corona zone. The overall number of CD20+ B cells was much lower. However, in 6 of 12 patients (50%), at least 1 B cell aggregate was present in the fibrovascular zone. Large numbers of cells expressing interleukin‐1β (IL‐1β) were observed in the corona zone. Transforming growth factor β1 (TGFβ1)–expressing mononucleated cells were also identified. The number of CD68+ cells correlated with the number of cells expressing IL‐1β (r = 0.691, P = 0.009) and the number expressing TGFβ1 (r = 0.518, P = 0.04).

Conclusion

The tophus represents a complex and organized chronic inflammatory tissue response to monosodium urate monohydrate crystals involving both innate and adaptive immune cells. The coexpression of IL‐1β and TGFβ1 suggests that both proinflammatory and antiinflammatory factors present within the tophus contribute to a cycle of chronic inflammation, attempted resolution, and tissue remodeling.

     

Acute myocardial infarction associated with acute gouty arthritis

The association of hyperuricemia with increased risk of atherosclerosis has been reported in previous studies but the link of acute gouty arthritis, hyperuricemia and acute myocardial infarction (MI) is not seen frequently. Here we report a 33 year old male who presented with hyperuricemia, acute gouty arthritis and acute myocardial infarction. Hyperuricemia contributed not only to accelerated atherosclerosis but might be blamed for promoting environment for acute myocardial infarction.     

Double-orifice mitral valve associated with nonisolated left ventricular noncompaction--a case report

Double-orifice mitral valve is a rare congenital anomaly. Although it is more frequently associated with other cardiac abnormalities, it may occur as an isolated lesion. There are 2 forms of myocardial noncompaction: isolated and nonisolated myocardial noncompaction. Nonisolated myocardial noncompactions are occasionally reported postnatally in association with congenital heart anomalies such as ventricular septal defect, pulmonic stenosis, and atrial septal defect. To our knowledge, this is the first case presentation reporting a double-orifice mitral valve associated with nonisolated myocardial noncompaction.     

Williams-Beuren syndrome associated with hammock mitral valve: First case report

Williams-Beuren syndrome (WBS) is a multisystem congenital disorder, whose cardiovascular defects are the leading cause of death. We present the case of a 38-year-old man with features of heart failure. The imaging studies showed a typical supravalvular aortic stenosis and a hammock mitral valve, this last, being a rare congenital disease. This is the first case reported of a hammock mitral valve in a patient with this chromosomopathy.