Renal and Splenic Infarctions: Unmasking Rheumatic Mitral Valve Disease in a Young Adult

Systemic thromboembolism is an uncommon but clinically significant complication of rheumatic heart disease (RHD), most often seen in association with infective endocarditis. We describe a 39-year-old woman with no known cardiovascular comorbidities who presented with acute left-sided abdominal pain. Imaging revealed concurrent renal and splenic infarctions. Further evaluation uncovered paroxysmal atrial fibrillation, severe mitral regurgitation, and moderate to severe mitral stenosis with marked left atrial enlargement. Transthoracic and transesophageal echocardiography confirmed the diagnosis. She was managed with anticoagulation, rate control, and subsequently underwent surgical intervention consisting of mitral valve replacement, tricuspid annuloplasty, and left atrial appendage closure. Postoperatively, the patient had an uneventful recovery, with stable vital signs, no evidence of thromboembolic events, and sustained sinus rhythm at discharge. Repeat echocardiography showed a well-seated and normally functioning mitral bioprosthesis, with no rocking motion and no significant trans-prosthetic or peri-prosthetic regurgitation. This case highlights the importance of considering RHD as a potential cause of systemic embolism, even in younger patients without traditional cardiovascular risk factors. It emphasizes the need for a thorough cardiovascular evaluation in patients presenting with systemic embolism to ensure early diagnosis and appropriate management.