Severe mitral stenosis secondary to eosinophilic granulomatosis resolving after pharmacological treatment
Ewa Szczerba MD
First Chair and Department of Cardiology, Medical University of Warsaw, Warsaw, Poland
Department of Cardiology, Institute of Mother and Child, Warsaw, Poland
Search for more papers by this authorRobert Kowalik MD, PhD
First Chair and Department of Cardiology, Medical University of Warsaw, Warsaw, Poland
Search for more papers by this authorCorresponding Author
Katarzyna Gorska MD, PhD
Department of Internal Medicine, Pulmonary Diseases and Allergy, Medical University of Warsaw, Warsaw, Poland
Correspondence
Katarzyna Górska, Department of Internal Medicine, Pulmonary Diseases and Allergy, Medical University of Warsaw, Warsaw, Poland.
Email: [email protected]
Search for more papers by this authorMichal Mierzejewski MD
Department of Internal Medicine, Pulmonary Diseases and Allergy, Medical University of Warsaw, Warsaw, Poland
Search for more papers by this authorAnna Slowikowska MD
Department of Cardiosurgery, Medical University of Warsaw, Warsaw, Poland
Search for more papers by this authorTomasz Bednarczyk MD
Students’ Scientific Group of First Chair and Department of Cardiology, Medical University of Warsaw, Warsaw, Poland
Search for more papers by this authorMichal Marchel MD, PhD
First Chair and Department of Cardiology, Medical University of Warsaw, Warsaw, Poland
Search for more papers by this authorRafal Krenke MD, PhD
Department of Internal Medicine, Pulmonary Diseases and Allergy, Medical University of Warsaw, Warsaw, Poland
Search for more papers by this authorGrzegorz Opolski MD, PhD
First Chair and Department of Cardiology, Medical University of Warsaw, Warsaw, Poland
Search for more papers by this authorEwa Szczerba MD
First Chair and Department of Cardiology, Medical University of Warsaw, Warsaw, Poland
Department of Cardiology, Institute of Mother and Child, Warsaw, Poland
Search for more papers by this authorRobert Kowalik MD, PhD
First Chair and Department of Cardiology, Medical University of Warsaw, Warsaw, Poland
Search for more papers by this authorCorresponding Author
Katarzyna Gorska MD, PhD
Department of Internal Medicine, Pulmonary Diseases and Allergy, Medical University of Warsaw, Warsaw, Poland
Correspondence
Katarzyna Górska, Department of Internal Medicine, Pulmonary Diseases and Allergy, Medical University of Warsaw, Warsaw, Poland.
Email: [email protected]
Search for more papers by this authorMichal Mierzejewski MD
Department of Internal Medicine, Pulmonary Diseases and Allergy, Medical University of Warsaw, Warsaw, Poland
Search for more papers by this authorAnna Slowikowska MD
Department of Cardiosurgery, Medical University of Warsaw, Warsaw, Poland
Search for more papers by this authorTomasz Bednarczyk MD
Students’ Scientific Group of First Chair and Department of Cardiology, Medical University of Warsaw, Warsaw, Poland
Search for more papers by this authorMichal Marchel MD, PhD
First Chair and Department of Cardiology, Medical University of Warsaw, Warsaw, Poland
Search for more papers by this authorRafal Krenke MD, PhD
Department of Internal Medicine, Pulmonary Diseases and Allergy, Medical University of Warsaw, Warsaw, Poland
Search for more papers by this authorGrzegorz Opolski MD, PhD
First Chair and Department of Cardiology, Medical University of Warsaw, Warsaw, Poland
Search for more papers by this authorAbstract
We present a case of 44-year-old woman who underwent effective pharmacological treatment of severe mitral stenosis. The patient was hospitalized due to rapidly progressive dyspnea. Her medical history included asthma, perennial rhinitis, and nasal polyps. Echocardiography showed a mass of the left ventricle involving the mitral valve; cardiac MRI suggested acute endocarditis. Severe peripheral blood eosinophilia was found. Eosinophilic granulomatosis with polyangiitis was diagnosed; treatment with prednisone and cyclophosphamide was started. Despite the clinical improvement, severe mitral stenosis persisted, surgical treatment was planned. However, evaluation after 6 cycles of cyclophosphamide pulse therapy revealed a significant regression of the valvular disease.
Supporting Information
| Filename | Description |
|---|---|
| echo14171-sup-0001-MovieS1.mpgMPEG video, 4.6 MB | Movie S1 (AP2). An irregular, isoechogenic mass attached to the basal segment of the inferior wall and ventricular surface of mitral leaflets with a mobile part on the apical pole of the mass visible in the apical dual-chamber view in transthoracic echocardiography. Ao desc. = descending aorta; LA = left atrium; LV = left ventricle; RV = right ventricle |
| echo14171-sup-0002-MovieS2.mpgMPEG video, 3.9 MB | Movie S2 (PLAX). The mass infiltrating both leaflets of the mitral valve, causing their impaired movement with doming of the leaflets and “hockey stick” shape of anterior leaflet in diastole in the parasternal long axis view in transthoracic echocardiography. Additionally, enlargement of the left atrium can be seen. Ao = ascending aorta; LA = left atrium; LV = left ventricle; RV = right ventricle. |
| echo14171-sup-0003-MovieS3.mpgMPEG video, 2.5 MB | Movie S3 (TEE). Biplane visualization of isoechogenic mass attached to the posterior leaflet and the free edge of anterior leaflet of the mitral valve in the midesophageal long-axis view (transesophageal echocardiography). Ao = ascending aorta; LA = left atrium; LV = left ventricle; RV = right ventricle. |
| echo14171-sup-0004-MovieS4.mpgMPEG video, 5.2 MB | Movie S4 (MRI). Vertical long axis view in magnetic cardiac resonance showing the mass attached to the basal segment of inferior wall and ventricular surface of the mitral leaflets with impairment of blood outflow from the left atrium. LA = left atrium; LV = left ventricle. |
| echo14171-sup-0005-MovieS5.mpegMPEG video, 5.4 MB | Movie S5 and 6 (SAX1 and SAX2). Both short axis views demonstrate impaired posterior mitral leaflet movement caused by the infiltrating mass in the left ventricle revealing the mechanism of mitral stenosis. The movement of the anterior leaflet of the mitral valve is proper. AML = anterior mitral leaflet, IVS = intraventricular septum, PML = posterior mitral leaflet, RV = right ventricle. |
| echo14171-sup-0006-MovieS6.mpegMPEG video, 5.1 MB |
Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.
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