Reversible aortic valve stenosis with Löffler endocarditis

Reversible aortic valve stenosis with Löffler endocarditis Cardiovascular flashlight 1 doi:10.1093/eurheartj/ehy094 CARDIOVASCULAR FLASHLIGHT .................................................................................................................................................... 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/advance-article-abstract/doi/10.1093/eurheartj/ehy094/4911114 by Ed 'DeepDyve' Gillespie user on 08 June 2018 http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png European Heart Journal Oxford University Press

Reversible aortic valve stenosis with Löffler endocarditis

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Oxford University Press
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Published on behalf of the European Society of Cardiology. All rights reserved. © The Author(s) 2018. For permissions, please email: journals.permissions@oup.com.
ISSN
0195-668X
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1522-9645
D.O.I.
10.1093/eurheartj/ehy094
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Abstract

Cardiovascular flashlight 1 doi:10.1093/eurheartj/ehy094 CARDIOVASCULAR FLASHLIGHT .................................................................................................................................................... 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/advance-article-abstract/doi/10.1093/eurheartj/ehy094/4911114 by Ed 'DeepDyve' Gillespie user on 08 June 2018

Journal

European Heart JournalOxford University Press

Published: Feb 26, 2018

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