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Persistent Fever After Minimally Invasive Mitral Valve Surgery: A Diagnostic Dilemma
Tamer M. Abdalghafoor, Ali Kindawi;
Hamad Medical Corporation, Doha, Qatar
Abstract: This case report describes the clinical course of a 57-year-old male patient admitted with infective endocarditis and subsequent complications of mitral regurgitation. The patient underwent minimally invasive mitral valve repair and experienced postoperative complications, including pericardial and pleural effusion, atrial fibrillation, and persistent fever. The management involved a multidisciplinary approach, including antibiotics, drainage procedures, anti-inflammatory medications, and corticosteroids. The patient eventually showed improvement and was discharged in stable condition.
Introduction: Infective endocarditis is a serious condition characterized by the infection of the endocardium, usually caused by bacteria. It can lead to various complications, including valvular dysfunction. Mitral regurgitation is a common consequence of infective endocarditis and may require surgical intervention. Post-pericardiotomy syndrome, characterized by pericardial inflammation, can occur after cardiac surgery. This case report highlights the challenges in managing these complications and the importance of a comprehensive approach.
Case Presentation:A 57-year-old male patient presented with fever and shortness of breath, diagnosed with infective endocarditis. The patient had a history of iron deficiency anemia due to gastrointestinal ulcerations. Echocardiograms revealed mitral regurgitation with valve morphology consistent with myxomatous proliferation and Flail P2 scallop secondary to ruptured chordae, necessitating surgical repair.
Management: Minimally invasive mitral valve repair was performed successfully, but the patient developed postoperative complications. These included pericardial and pleural effusion, atrial fibrillation, and persistent fever. Antibiotics were administered, and drainage procedures were performed to manage the effusions. Anti-inflammatory medications, including colchicine and ibuprofen, were added to the treatment regimen. A PET scan revealed intense pericardial uptake, suggesting post-pericardiotomy syndrome. Prednisolone was introduced due to the slow patient response.
Outcome: After a few days of combination therapy, the patient’s fever subsided, chest pain improved, and inflammatory markers decreased. Further investigation for inflammatory bowel disease was inconclusive. The patient was eventually discharged in a stable condition.
Conclusion: This case report highlights the challenges encountered in managing infective endocarditis complicated by mitral regurgitation and post-pericardiotomy syndrome. A multidisciplinary approach involving antibiotics, drainage procedures, anti-inflammatory medications, and corticosteroids was effective in improving the patient’s condition. Further research is needed to better understand the optimal management strategies for these complications.
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