Double site left heart endocarditis with ventricular outflow tract mural vegetation

Abstract

A 39-year-old man was admitted for a febrile congestive heart failure. Echocardiography revealed large vegetations on the mitral and aortic valves associated to a large mobile vegetation attached to the left ventricular outflow wall. Three days after the initiation of an intensive medical and antibiotic therapy, he underwent a double prosthetic valve replacement because of massive mitral regurgitation with cardiac heart failure. Culture of the vegetations identified a streptococcus. Long term outcome was uneventful. Bacterial inoculation of the parietal endocardium in valvular endocarditis is extremely rare and was probably due to lesions caused by previous regurgitation in our patient.