Endocarditis on Prosthetic Mitral Valves

Fatal Obstruction to Left Ventricular Inflow

¹ Departments of Medicine and Surgery, the Lexington Veterans Administration Hospital and the University of Kentucky Medical Center, Lexington

In two patients with bacterial prosthetic mitral valve endocarditis, death occurred from hemodynamic compromise after development of obstruction to left ventricular inflow by a membrane on the atrial surface of the prosthesis. One patient had a disc valve infected by Bacillus antitratum; the other, a Starr-Edwards ball valve infected by Staphylococcus epidermidis. In neither patient was evidence of new valvular dysfunction detected clinically or by fluoroscopy during the course of the infection. This complication of prosthetic valve insertion appears to progress rapidly in spite of antibiotic therapy. Early diagnosis is imperative and may be aided by bedside determination of pulmonary arterial wedge presures.