A Case of Myocardial Abscess Complicating Mitral Valve Infective Endocarditis due to Klebsiella pneumoniae

(Department of Cardiovascular Surgery, Hyogo Brain and Heart Center at Himeji, Himeji, Japan)

Masato Yoshida Nobuhiko Mukohara Hidefumi Obo
Keitaro Nakagiri Hiroya Minami Tomoki Hanada
Ayako Maruo Hironori Matsuhisa Naoto Morimoto
Tsutomu Shida
A 65-year-old-man was admitted with congestive heart failure and septic shock associated with suspected mitral valve infective endocarditis. An echocardiogram revealed vegetation attached to the chordae, high density lesions in both papillary muscles, and severe mitral regurgitation. An emergency operation was performed. Vegetation was been attached to the chordae. Multiple myocardial abscesses were noted in both papillary muscles and surrounding myocardium. However, there were few noticeable lesions on mitral valve leaflets and annulus. The anterior mitral leaflet was resected together with the chordae and the papillary muscles containing the myocardial abscesses. Mitral valve replacement was performed using a 27mm SJM valve after the other myocardial abscesses were drained. Klebsiella pneumoniae was cultured from the vegetation and the myocardial abscesses. Cases of myocardial abscess associated with infective endocarditis at the site of the papillary muscles and in the areas of the myocardium are very rare. It was assumed that the myocardial abscesses were probably due to the septic state from infective endocarditis, since myocardial abscesses was recognized in multiple sites and at a distance from the valve leaflets and annulus.
@Jpn. J. Cardiovasc. Surg. 33: 64 -67 (2004)