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)