Penetrating mitral annular abscess ruptured into the left atrium: a rare cause of mitral regurgitation

Description

A man aged 27 years from Bangladesh was referred to our centre for evaluation of fever of unknown origin of 3 months duration. There was a history of progressively increasing dyspnoea of NYHA functional class II for 25 days. He had received antibiotic therapy for a week prior to his presentation to us. Physical examination revealed muffled first heart sound with loud pulmonary component of second heart sound. A grade IV/VI (Levine grade) pan systolic murmur was heard over the apex, radiating to the left axillae. There were no clinical stigmata of infective endocarditis. Blood cultures were sterile. ECG showed sinus rhythm with left atrial enlargement and chest X-ray was suggestive of moderate cardiomegaly (cardiothoracic ratio 65%). Transthoracic echocardiogram (TTE) (figures 1 and 2 and video 1) revealed features of severe mitral regurgitation, with a ruptured abscess cavity (yellow arrow) involving the posterior...

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