Posterior Mitral Leaflet Prolapse and Subsequent Mitral Valve Endocarditis Complicated With Anterior Leaflet Perforation

A 68-year-old male presented with a two-week history of fever, and further investigations revealed mitral valve endocarditis caused by Staphylococcus epidermidis, with associated severe mitral regurgitation (MR). The patient was referred for mitral valve surgery but developed new neurological symptoms two days before the operation, which were diagnosed as symptomatic epilepsy. During surgery, kissing lesions were found on the posterior mitral leaflet (PML), which were not detected on preoperative transesophageal echocardiography (TEE). Mitral valve repair was completed using autologous pericardium. The current case highlights the importance of careful examination of leaflets during surgery and not relying solely on preoperative imaging to detect all lesions. It is essential to promptly diagnose and treat infective endocarditis to prevent further complications and ensure successful outcomes.

Automated summary

A 68-year-old male presented with fever for two weeks, and investigations revealed mitral valve endocarditis caused by Staphylococcus epidermidis, with severe mitral regurgitation. The patient was scheduled for mitral valve surgery but developed new neurological symptoms two days prior, being diagnosed with symptomatic epilepsy. Kissing lesions were found during surgery on the posterior mitral leaflet, which were not detected on preoperative transesophageal echocardiography. This case highlights the importance of careful examination during surgery and prompt diagnosis and treatment of infective endocarditis for successful outcomes.