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Severe mitral regurgitation in acute eosinophilic endomyocarditis: repair or replacement?

^a Division of Cardiovascular Surgery, Toronto General Hospital, 200 Elizabeth Street, Toronto, Ont., Canada ON M5G 2C4
^b Division of Anesthesia, Toronto General Hospital, Toronto, Ont., Canada ON M5G 2C4
^c Division of Pathology, Toronto General Hospital, Toronto, Ont., Canada ON M5G 2C4

^* Corresponding author. Tel.: +1-416-340-4789, fax: +1-416-340-3803
gus{at}tang-family.org

Established eosinophilic endomyocardial disease usually causes progressive heart failure from diastolic restriction and/or valvular dysfunction. Surgical treatment typically involves resection of endoventricular fibrosis and atrioventricular valve replacement. However, little is known of the clinicopathological behaviour and perioperative course of this disease in the early stages. Mitral valve repair seemingly offers an attractive surgical option in this scenario as it avoids prosthetic thrombosis—a recognized late complication of this disease. This was attempted in conjunction with left ventricular thrombectomy in a patient with acute hypereosinophilia and congestive heart failure associated with severe mitral regurgitation and restrictive cardiomyopathy. Although the early clinical and echocardiographic outcome was excellent, the patient deteriorated rapidly after 3 months when identical pathology relapsed in the left heart causing recurrent severe mitral regurgitation and heart failure. Cardiac function improved markedly following a redo bioprosthetic mitral valve replacement. Prosthetic valve function remained satisfactory until death occurred 2 months later from refractory acute lymphocytic leukaemia. Rapid disease recurrence jeopardizing a conserved mitral valve in acute eosinophilic endomyocarditis cautions against surgical repair despite its many advantages. A bioprosthesis is associated with reduced thrombotic complications and may be the treatment of choice for this rare pathology.

Key Words: Mitral valve repair; Thrombosis; Heart failure; Endocarditis