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Bacterial Endocarditis and Functional Mitral Stenosis*: A Report of Two Cases and Brief Literature Review

Irving Y. Tiong, MD; Gian M. Novaro, MD; Brian Jefferson, MD; Michael Monson, MD; Nicholas Smedira, MD, FCCP; Marc S. Penn, MD, PhD
Author and Funding Information

*From the Department of Cardiovascular Medicine (Drs. Novaro, Jefferson, Monson, and Penn), Internal Medicine (Dr. Tiong), and Cardiothoracic Surgery (Dr. Smedira), The Cleveland Clinic Foundation, Cleveland, OH.

Correspondence to: Marc S. Penn, MD, PhD, Departments of Cardiovascular Medicine and Cell Biology, NC10, Cleveland Clinic Foundation, 9500 Euclid Ave, Cleveland, OH 44195; e-mail: pennm@ccf.org



Chest. 2002;122(6):2259-2262. doi:10.1378/chest.122.6.2259
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Mitral valve endocarditis typically results in mitral regurgitation. However, endocarditis leading to functional mitral stenosis is uncommon and, when present, fungal organisms are typically implicated. Thus, obstructive-type bacterial endocarditis due to large vegetations blocking the mitral valve orifice is a rare occurrence, with approximately 20 reported cases in the literature. We report on two patients with bacterial endocarditis and severe functional mitral stenosis requiring emergent surgery. Additionally, this is the first report of vancomycin-resistant enterococcus causing endocarditis and functional mitral stenosis. The discussion emphasizes the hemodynamic instability of these patients and need for early surgical intervention.

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