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Unilateral pulmonary edema secondary to mitral valve perforation.
| Content Provider | Semantic Scholar |
|---|---|
| Author | Warraich, Haider Javed Bhatti, Umer Aziz Shahul, Sajid S. Pinto, Duane S. Liu, David J. T. Matyal, Robina Mahmood, Fatin Fathel |
| Copyright Year | 2011 |
| Abstract | 52-year-old hypertensive man, with a 40–pack-a-yearsmoking history, presented to an outside hospital withdyspnea, fever, and cough. Chest x-ray demonstrated right-sided infiltrates. He was treated with antibiotics for presumedpneumonia. However, the patient presented the followingmorning with worsening dyspnea and hemoptysis. Bronchio-alveolar lavage and right lung biopsy under general anesthe-sia were nondiagnostic. The patient was transferred to ourinstitution for further management.At our hospital, chest auscultation revealed a systolicmurmur consistent with mitral regurgitation (MR). Chestx-ray and computed tomography scan confirmed unilateralinfiltrates (Figure 1). After transesophageal echocardiog-raphy (TEE) demonstrated moderate aortic stenosis and4 MR, raising the possibility of a mitral valve (MV)perforation, the patient was scheduled for urgent surgery.Intraoperative precardiopulmonary bypass 2D TEE con-firmed the presence of severe aortic stenosis. Interrogationof the MV showed thickened leaflets with good leafletexcursion and a possible perforation in the A2 scallopregion. Color flow Doppler interrogation of the MVdemonstrated the MR jet eccentrically directed toward theright upper pulmonary vein (Movie I in the online-onlyData Supplement). Pulse wave Doppler revealed isolatedsystolic flow reversal in the right upper pulmonary vein(Figure 2). With the use of 3D TEE, a large perforation inthe A2 scallop was visualized (Movie II in the online-onlyData Supplement). Subsequently, the patient underwent anuneventful double-valve replacement. Postbypass TEEshowed well-seated prosthetic valves with minimal regur-gitation. Further course was unremarkable. The pathologyreport of the excised MV (Figure 3) revealed no evidenceof infective endocarditis.Unilateral pulmonary edema is commonly associated witheccentric MR, presenting as unilateral pulmonary infiltrates. |
| Starting Page | 89 |
| Ending Page | 103 |
| Page Count | 15 |
| File Format | PDF HTM / HTML |
| Alternate Webpage(s) | http://circ.ahajournals.org/content/circulationaha/124/18/1994.full.pdf |
| Alternate Webpage(s) | http://circ.ahajournals.org/content/circulationaha/124/18/1994.full.pdf?download=true |
| PubMed reference number | 22042928v1 |
| Alternate Webpage(s) | https://doi.org/10.1161/CIRCULATIONAHA.111.032656 |
| DOI | 10.1161/circulationaha.111.032656 |
| Journal | Circulation |
| Volume Number | 124 |
| Issue Number | 18 |
| Language | English |
| Access Restriction | Open |
| Subject Keyword | Aortic Valve Stenosis Atelectasis Auscultation Bacterial Endocarditis Bronchial obstruction Bronchoalveolar Lavage Fluid Contusions Coughing Diagnostic Techniques, Urological Differential Diagnosis Dyspnea Echocardiography Echocardiography, Transesophageal Fever Heart Atrium Hemoptysis Hepatic Veno-Occlusive Disease Hypertensive disease Infiltration Irrigation Lung diseases Medical Device Material Perforation Mitral Valve Insufficiency Mitral Valve Stenosis Neoplasms Patients Plain chest X-ray Plain x-ray Pneumonia Pulmonary Edema Pulmonary veins Regurgitation Schedule (document type) Tuberculosis, Pulmonary Venoocclusive disease X-Ray Computed Tomography corneal infiltrates pathology report |
| Content Type | Text |
| Resource Type | Article |
