Acute on Chronic Rheumatic Valvulitis

Figures

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  Figure 1. Chest Radiograph Initial chest radiograph demonstrated severe cardiomegaly, left bronchial compression, and diffuse pulmonary edema consistent with mitral valvulitis and severe regurgitation.

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  Figure 2. Echocardiographic Findings (A) Three-dimensional en face view of the mitral valve leaflets viewed from the left ventricle showing nodular thickening of both leaflets (arrowheads) in diastole. (B) Parasternal long-axis view of the mitral valve leaflets in diastole showing thickening of both leaflets (arrowheads). (C) Apical long-axis view of the mitral valve leaflets in systole showing evidence of flail anterior mitral leaflet (arrow) and poor coaptation with the tethered posterior leaflet. (D) Apical long-axis view of the mitral valve leaflets in systole showing severe mitral regurgitation via a posteriorly deviated jet through the flail anterior mitral leaflet (arrow).

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  Figure 3. Educational Diagram Diagram used for family and bedside provider education, demonstrating cardiomegaly with significant left atrial dilation, thickened mitral valve leaflets, and severe mitral regurgitation.

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  Figure 4. Intraoperative Picture Gross intraoperative photograph of pericardium with extensive gelatinous adhesions.

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  Figure 5. Histology and Histopathology (A) Gross photograph of thickened, inflamed anterior mitral valve leaflet and chordae tendineae. (B) Low power view of thickened leaflet with fibrosis and inflammation. (C) High power view of Anitschkow histiocytes with typical caterpillar-like nuclei. (D) Chronic valvulitis with fibrosis, lymphocytic infiltrates, and neovascularization. (E) Acute valvulitis with histiocytic infiltrates suggesting Aschoff bodies (lower left) and focally prominent neutrophils (upper right). (F) Mixed inflammatory infiltrates with focal Anitschkow histiocytes (circle).