INVESTIGATIONS
Laboratory data showed white blood cell: 5300 cell/mm3with 85% neutrophils, hemoglobin: 10.6 g/dl, creatinine: 2.5mg/dl, ESR:
85 and CRP: 3plus. In next days of admission, we had 3 times negative
blood culture, also negative urine and stool cultures and negative tests
for Brucellosis.
Electrocardiogram (ECG) showed normal sinus rhythm. Transthoracic
echocardiography (TTE) and transesophageal echocardiography (TEE) showed
severe left ventricle (LV) enlargement with ejection fraction (EF):
50-55%, mild right ventricular dilation with moderate dysfunction,
severe posterior mitral annular calcification with mild stenosis and
severe primary and moderate diastolic mitral regurgitation (MR).
Bioprosthetic AV was calcified, destructed, perforated and flail with
significant stenosis and severe free regurgitation and multiple
hypermobile masses with the largest one measured about 1 centimeter,
systolic pulmonary artery pressure(sPAP) was about 85mmHg. Premature
closure of mitral valve, diastolic MR, and high LV end diastolic
pressure all were suggestive for an acute aortic regurgitation.
(Figure.1, Video.1)