Hemangioma of the mitral valve: Following the murmur

Cardiac hemangiomas are an exceedingly rare condition, with about 100 cases described in the literature, of which only 13 were valvular. We report the case of a 66-year-old woman, with no prior cardiovascular disease, who presented with an abdominal infection caused by Enterococcus faecalis, complicated by recrudescent fever and new-onset systolic mitral murmur. The transesophageal echocardiogram revealed a large vegetation on the posterior leaflet of the mitral valve, with a high embolic risk, leading to a diagnosis of acute endocarditis. The patient began antibiotics, with no clinical improvement, developing severe heart failure and coronary and cerebrovascular embolic phenomena, and underwent excision of the mass and placement of a biological mitral prosthesis. The histopathologic analysis revealed a cavernous hemangioma. Eight months later, the patient presented with recurrence of acute bacterial endocarditis and septic shock, and underwent replacement of the prosthetic valve. The histologic exam showed no signs of hemangioma. The rarity of this case and its complications make its presentation relevant.