Niedomykalność zastawki mitralnej w przebiegu zapalenia wsierdzia u ciężarnej – opis przypadku

*Lidia Łysenko¹, Grażyna Durek¹, Halina Nowosad², Wojciech Kustrzycki²

Summary
Background.Infective endocarditis (IE) in pregnancy occurs rarely. Congenital or acquired cardiac defects are contributing factors. Endocarditis may complicate sepsis caused by abortion, premature rupture of membranes, prolonged delivery, and/or Caesarean section.
Case report. We present a case of IE that occurred in a 27-year-old primagravida in the 36^th week of pregnancy, who developed clinical signs of sepsis when being treated in the obstetric department for premature contractions. Two years earlier, she had been treated for endocarditis, which resulted in partial damage to the mitral valve and marginal prolapse. The most probable source of infection was a peripheral intravenous catheter, inserted in the obstetric department. Emergency Caesarean section was performed, and the patient was transferred to the intensive care ward, where she developed severe ARDS and Gram-positive septicemia. Because of progressive cardiac failure and persistent systolic murmur, oesophageal echocardiography was performed, revealing critical mitral insufficiency caused by endocarditis. Emergency valve replacement was performed under extracorporeal circulation. The patient was extubated 20 hours after the surgery and made a satisfactory recovery.
Discussion. The true diagnosis in the described case was difficult to determine, as the observed pathology of the mitral valve was at first attributed to pre-existing pathology. The first blood cultures were negative, which also delayed proper antibiotic therapy. Progressive cardiac failure and transoesophageal echocardiography hastened surgical intervention.

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