ALTHOUGH life-threatening hemodynamic abnormalities from valvular incompetence constitute a widely recognized complication of infective endocarditis, severe valvular obstruction by the vegetations characteristic of this disease has been reported infrequently,1,2 and the diagnosis has usually been established at autopsy. Such obstruction may escape recognition since the clinical manifestations to which it gives rise can be suggestive of myocardial decompensation.
In the patient described here, life-threatening mitral obstruction developed late in the course of staphylococcal endocarditis. Cardiac catheterization confirmed the diagnosis, and surgical correction was successful.
Report of a Case
A 51-year-old man was known to have rheumatic heart disease. In July 1973, his condition was categorized as cardiac class II, and his isolated mitral stenosis was judged to be moderate in degree and not to require surgical intervention.In late August 1973, the patient came to the Kaiser Foundation Hospital, San Francisco, with rigor and cough of 24 hours' duration.