Reversible aortic valve stenosis with Löffler endocarditis
Reversible aortic valve stenosis with Löffler endocarditis
Yamamoto, Masayoshi;Seo, Yoshihiro;Ishizu, Tomoko;Aonuma, Kazutaka
2018-02-26 00:00:00
2332 Cardiovascular flashlight doi:10.1093/eurheartj/ehy094 CARDIOVASCULAR FLASHLIGHT Online publish-ahead-of-print 26 February 2018 .................................................................................................................................................... Reversible aortic valve stenosis with Lo¨ffler endocarditis Masayoshi Yamamoto, Yoshihiro Seo*, Tomoko Ishizu, and Kazutaka Aonuma Cardiovascular Division, Institute of Clinical Medicine, Graduate School of Comprehensive Human Sciences, University of Tsukuba, 1-1-1 Tennodai, Ibaraki, Tsukuba 305- 8575, Japan * Corresponding author. Tel: 181 298 53 3142, Fax: 181-298-53-3143, Email: yo-seo@md.tsukuba.ac.jp A 76-year-old man hospitalized for acute heart failure had marked eosinophilia (white blood cells: 35.4 10 /lL, with 83% eosinophils: 29.3 10 /lL). He was diagnosed with idiopathic eosinophilia following detailed evaluation including bone marrow biopsy. A 2D transthoracic echocardiography showed obliteration of the right ventricular apex which is typical view for Lo¨ffler endocarditis with normal left ventricular ejection fraction of 56% (Panel A, arrow indicates “apical thrombus in the right ventricle”), and peak aortic valve velocity was 4.1 ms .Right ventricular endomyocardial biopsy showed infiltration with fibrin-containing thrombus and eosinophils (Panel B,scale bar: 100 lm), and Lo¨ffler endocarditis was diagnosed. Transoesophageal echocardiography showed severe aortic valve stenosis (aortic valve area by planimetry: 0.70 cm ) with fusion of three leaflets to create an unicuspid valve (Panel C;see Supplementary material online, Video S1). Oral prednisolone (30 mg/day) and hydroxyurea (500 mg/day) were started for Lo¨ffler endocarditis. After three months of treatment, he was scheduled for aortic 3 3 valve replacement. However, eosinophilia was dramatically improved (white blood cells: 12.3 10 /lL, with 29% eosinophils: 3.54 10 /lL), and fusion of the aortic valve leaflets had disappeared (Panel D;see Supplementary material online, Video S2). Peak aortic valve velocity was 1 1 reduced from 4.1 ms to 2.0 ms . He did not undergo surgery and has had no recurrence of aortic valve stenosis and heart failure in the past 2 years. In patients with Lo¨ffler endocarditis, valves most commonly involved are atrioventricular valves with regurgitation and less commonly aortic valve. This is a quite unusual case of Lo¨ffler endocarditis and aortic valve stenosis improved by immunosuppressive treatment. Supplementary material is available at European Heart Journal online. Published on behalf of the European Society of Cardiology. All rights reserved. V The Author(s) 2018. For permissions, please email: journals.permissions@oup.com. Downloaded from https://academic.oup.com/eurheartj/article-abstract/39/24/2332/4911114 by Ed 'DeepDyve' Gillespie user on 26 June 2018
http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.pngEuropean Heart JournalOxford University Presshttp://www.deepdyve.com/lp/oxford-university-press/reversible-aortic-valve-stenosis-with-l-ffler-endocarditis-OeL0AEGTN7
Reversible aortic valve stenosis with Löffler endocarditis
2332 Cardiovascular flashlight doi:10.1093/eurheartj/ehy094 CARDIOVASCULAR FLASHLIGHT Online publish-ahead-of-print 26 February 2018 .................................................................................................................................................... Reversible aortic valve stenosis with Lo¨ffler endocarditis Masayoshi Yamamoto, Yoshihiro Seo*, Tomoko Ishizu, and Kazutaka Aonuma Cardiovascular Division, Institute of Clinical Medicine, Graduate School of Comprehensive Human Sciences, University of Tsukuba, 1-1-1 Tennodai, Ibaraki, Tsukuba 305- 8575, Japan * Corresponding author. Tel: 181 298 53 3142, Fax: 181-298-53-3143, Email: yo-seo@md.tsukuba.ac.jp A 76-year-old man hospitalized for acute heart failure had marked eosinophilia (white blood cells: 35.4 10 /lL, with 83% eosinophils: 29.3 10 /lL). He was diagnosed with idiopathic eosinophilia following detailed evaluation including bone marrow biopsy. A 2D transthoracic echocardiography showed obliteration of the right ventricular apex which is typical view for Lo¨ffler endocarditis with normal left ventricular ejection fraction of 56% (Panel A, arrow indicates “apical thrombus in the right ventricle”), and peak aortic valve velocity was 4.1 ms .Right ventricular endomyocardial biopsy showed infiltration with fibrin-containing thrombus and eosinophils (Panel B,scale bar: 100 lm), and Lo¨ffler endocarditis was diagnosed. Transoesophageal echocardiography showed severe aortic valve stenosis (aortic valve area by planimetry: 0.70 cm ) with fusion of three leaflets to create an unicuspid valve (Panel C;see Supplementary material online, Video S1). Oral prednisolone (30 mg/day) and hydroxyurea (500 mg/day) were started for Lo¨ffler endocarditis. After three months of treatment, he was scheduled for aortic 3 3 valve replacement. However, eosinophilia was dramatically improved (white blood cells: 12.3 10 /lL, with 29% eosinophils: 3.54 10 /lL), and fusion of the aortic valve leaflets had disappeared (Panel D;see Supplementary material online, Video S2). Peak aortic valve velocity was 1 1 reduced from 4.1 ms to 2.0 ms . He did not undergo surgery and has had no recurrence of aortic valve stenosis and heart failure in the past 2 years. In patients with Lo¨ffler endocarditis, valves most commonly involved are atrioventricular valves with regurgitation and less commonly aortic valve. This is a quite unusual case of Lo¨ffler endocarditis and aortic valve stenosis improved by immunosuppressive treatment. Supplementary material is available at European Heart Journal online. Published on behalf of the European Society of Cardiology. All rights reserved. V The Author(s) 2018. For permissions, please email: journals.permissions@oup.com. Downloaded from https://academic.oup.com/eurheartj/article-abstract/39/24/2332/4911114 by Ed 'DeepDyve' Gillespie user on 26 June 2018
Journal
European Heart Journal
– Oxford University Press
Published: Feb 26, 2018
Recommended Articles
Loading...
There are no references for this article.
You’re reading a free preview. Subscribe to read the entire article.
“Hi guys, I cannot tell you how much I love this resource. Incredible. I really believe you've hit the nail on the head with this site in regards to solving the research-purchase issue.”
Daniel C.
“Whoa! It’s like Spotify but for academic articles.”
@Phil_Robichaud
“I must say, @deepdyve is a fabulous solution to the independent researcher's problem of #access to #information.”
@deepthiw
“My last article couldn't be possible without the platform @deepdyve that makes journal papers cheaper.”
To get new article updates from a journal on your personalized homepage, please log in first, or sign up for a DeepDyve account if you don’t already have one.
Our policy towards the use of cookies
All DeepDyve websites use cookies to improve your online experience. They were placed on your computer when you launched this website. You can change your cookie settings through your browser.