Streptococcus agalactiae infective endocarditis with large vegetation in a patient with underlying protein S deficiency
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We present a case of a patient with underlying protein S deficiency who suffered from infective endocarditis with a large anterior mitral leaflet (AML) mass of approximately 4.5 cm in length. Intraoperative transesophageal echocardiography (TEE) revealed the mass at the AML base and a rupture of the posterior mitral leaflet chordae tendinae. The vegetation’s large size may have been caused by one or more of three factors: location, underlying disease, and the microorganism causing infection. Patients with protein S deficiency are prone to thromboembolic events during cardiac surgery. Infective endocarditis caused by Streptococcus agalactiae usually has a poor prognosis, and, thus, early surgery is recommended.
KeywordsStreptococcus agalactiae Infective endocarditis Protein S deficiency Vegetation Mitral valve Transesophageal echocardiography
Conflict of interest
Supplementary Video 1. Real-time 3D transesophageal echocardiography (TEE) (3D zoom mode, en-face view from atrial aspect) disclosed the mass attached to the junction of the anterior mitral leaflet (AML) base and interatrial septum. There was also posterior mitral leaflet (PML) flail at P2 due to chordae tendinae rupture (MPEG 3976 kb)
Supplementary Video 2. Real-time 3D transesophageal echocardiography (TEE) (3D full-volume color Doppler mode) revealed that the protruding mass partially obstructed the eccentric regurgitant jet of flail PML and, thus, reduced the mitral regurgitation (MR) severity (MPEG 3760 kb)