Early Prosthetic Valve Endocarditis with Mycobacterium Tuberculosis after Mitral Valve Replacement: A Case Report

Background: Tuberculous endocarditis is a rare but serious complication of heart valve replacement surgery. We report the case of a 24-year-old patient, who presented with tuberculous endocarditis after mechanical mitral valve replacement, with a favorable clinical course following anti-tuberculosis treatment. Case Presentation: We report a 24-year-old male patient, admitted to the cardiac surgery department of the Fann Hospital (Dakar, Senegal), for the management of severe mixed (rheumatic and endocarditic) mitral insufficiency with associated tricuspid insufficiency. He had a history of recurrent angina and polyarthralgia in childhood, was hospitalized several times for refractory global cardiac decompensation, and for a suspected infective endocarditis a month before his admission. On admission, the clinical examination revealed signs suggestive of mitral and tricuspid insufficiency. Transthoracic echocardiography revealed severe post-endocarditic mitral insufficiency with A3 amputation, highly mobile 15 mm vegetations on the free edge of the large valve, moderate tricuspid insufficiency, and severe pulmonary artery hypertension. Mechanical mitral valve replacement and tricuspid valve annuloplasty using autologous pericardial strip were performed via median sternotomy. After ten days, the patient presented with global cardiac decompensation associated with a clinico-biological infectious syndrome, and tans-oesophageal echography revealed an abscess at the sinotubular junction, communicating with the aorta. A thoraco-abdomino-pelvic CT scan was done, which revealed a bilateral alveolar-interstitial syndrome with mediastinal lymphadenopathy. Anti-tuberculosis treatment with RHZE was initiated for 06 months. The clinical course was favorable. Conclusion: Tuberculous endocarditis in prostheses is a serious complication of heart valve replacement surgery, which may evolve favorably under medical treatment.

Cardiac Myxoma: 10 Years Study of Presentations, Resection and Outcome

Background: Cardiac myxoma is a very rare heart tumor which presents as life threatening mass in cardiac chamber. The tumor may present with vague symptoms which can lead to delay in diagnosis. Methods: 22 patients underwent complete excision of intracardiac myxoma between January 2011 and December 2020. Majority of the patients were females (60%) with mean age of 48.9 years who presented with symptoms of dyspnea on exertion. 3 patients had significant complications due to myxoma. 2 presenting with tumor embolism and limb ischemia while 1 patient presented with pulmonary edema. All patients were diagnosed by echocardiography which helped in evaluation of size and extent of tumor. Majority of patients underwent trans-septal biatrial approach for tumor excision. Results: 95% of patients survived the operation. The mean tumor size excised was 5.0 ± 1.6 cm in the largest diameter. 11 patients had sessile tumor while 1 patient had dumb bell tumor occupying both atria. 15 patients were surviving the operation while 2 deaths happened after 6 years of surgery. Conclusion: Cardiac myxomas are rare tumors which can cause severe systemic and cardiac symptoms in patients. Early diagnosis and immediate surgical management give excellent early and long-term results.