Ahmed Rafsan, Moaddab Amirhossein, Graham-Hill Suzette
Internal Medicine, State University of New York Downstate Health Sciences University, Brooklyn, USA.
Cardiology, State University of New York Downstate Health Sciences University, Brooklyn, USA.
Cureus. 2022 Jun 11;14(6):e25854. doi: 10.7759/cureus.25854. eCollection 2022 Jun.
Infective Endocarditis (IE) refers to an infection of the endocardial surface of the heart which leads to a wide array of complications, including heart failure, perivalvular abscess, metastatic infection, septic embolization, mycotic aneurysms, neurological and renal complications. Mitral leaflet flail (MLF), defined as a failure of leaflet coaptation with the rapid systolic movement of the involved leaflet into the left atrium, is a rare complication of IE which can lead to severe mitral regurgitation. Echocardiography plays a key role in making its diagnosis with transesophageal echocardiograms (TEE), providing greater sensitivity and specificity compared to transthoracic echocardiograms (TTE). MLF is often misdiagnosed, or diagnosis is delayed due to its presentation with non-specific cardiac symptoms. However, early diagnosis with echocardiography and prompt surgical correction leads to improved long-term survival. Here we have presented a case of a 71-year-old female with a past medical history of IE nine years ago who was referred to the cardiology clinic for one month of exertional dyspnea. TTE showed severe mitral regurgitation, and subsequent TEE confirmed flail mitral leaflet.
感染性心内膜炎（IE）是指心脏内膜表面的感染，可导致一系列并发症，包括心力衰竭、瓣周脓肿、转移性感染、脓毒性栓塞、真菌性动脉瘤、神经和肾脏并发症。二尖瓣叶连枷样运动（MLF）定义为瓣叶对合失败，受累瓣叶在收缩期快速移入左心房，是IE的一种罕见并发症，可导致严重二尖瓣反流。超声心动图在通过经食管超声心动图（TEE）进行诊断中起关键作用，与经胸超声心动图（TTE）相比，具有更高的敏感性和特异性。MLF常被误诊，或因表现为非特异性心脏症状而诊断延迟。然而，通过超声心动图早期诊断并及时进行手术矫正可提高长期生存率。在此，我们报告一例71岁女性患者，该患者9年前有IE病史，因劳力性呼吸困难1个月转诊至心脏病诊所。TTE显示严重二尖瓣反流，随后TEE证实二尖瓣叶连枷样运动。
