coronary dissection Case: Female 29 years old , rheumatic m | Figure 1

coronary dissection

Case: Female 29 years old, rheumatic mitral stenosis. Symptoms: fatigue.

Conduct: Emergency surgery. Coronary artery bypass grafting and valve exchange.

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pt with prior #Aortic-valve replacement (orange arrow) and #Mitral-valve repair (blue arrow), in for #Catheterization to check #Coronary-arteries for TAVR next month. Pt had #Rheumatic-fever as child. Previous valve replaced 2008, now needs new aortic valve.

Image Description: (A) Angiogram of left anterior descending coronary artery showing 100% occlusion without evidence of atherosclerotic coronary artery disease concerning for a septic embolus (blue arrow). (B) Transesophageal echo view showing medium-sized, 1.3 cm (L) × 1.0 cm (W), mobile vegetation on the atrial aspect of the tip of the anterior leaflet of mitral valve (red arrow). (C) Gross specimen showing vegetation involving the mitral valve leaflets. Case Description: Acute myocardial infarction (AMI) is a rare but recognized and potentially serious complication of infective endocarditis (IE). This case describes the challenges surrounding the management of AMI in the setting of septic coronary embolism, brain, spleen, and kidney infarcts due to septic emboli from native mitral valve IE.

Pre and post #Mitral-valve clipping](https://app.figure1.com/case-detail/819d20dd-5fad-4e0e-91b5-c6abc193ed95)

Flail #Mitral-valve secondary to large vegetation. #Endocarditis pt septic, intubated.](https://app.figure1.com/case-detail/85676618-1588-4235-8d66-4e7c73e792be)

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