IMAGES IN CARDIOLOGY
Complex Mitral Valve Endocarditis
Involving a Left Atrial False Tendon
Sumeet K. Chhabra, MD,* Linda J. Bogar, MD,† Matthew V. DeCaro, MD,* Ira S. Cohen, MD*
From the *Division of
Cardiology, Department of
Medicine, Thomas Jefferson
and the †Division of
Department of Surgery,
Thomas Jefferson University
February 28, 2012;
accepted March 7, 2012.
Transthoracic echocardiography revealed severe mitral regurgitation and a 25 ? 18-mm
mobile vegetation adherent to the anterior mitral leaflet (A). A 30-mm echodense linear
structure connected the vegetation to the left atrial wall adjacent to the noncoronary sinus
of Valsalva (B, green arrow; Online Video 1). Two- and 3-dimensional transesophageal
echocardiography identified the structure as a false tendon (C and D, Online Video 2).
The patient underwent mitral valve replacement, and surgical findings confirmed complex
anterior leaflet endocarditis with an attached tan/white fibrous tissue fragment (E and F).
False tendons between the mitral valve and the left atrial wall are rare and have been re-
ported as a cause of mitral valve prolapse. To our knowledge, this is the first reported case
of subacute mitral valve endocarditis involving a false tendon (1).
33-year-old man with a history of mitral valve prolapse and a dental procedure
2 months earlier was admitted with fever. Examination revealed a holosystolic
murmur at the apex, and blood cultures were positive for Streptococcus mitis.
1. Baran T, Küçükog ˘lu MS, Ökçün B, Çetin G, Hatemi AC,
band. Echocardiography 2003;20:83–5.
Journal of the American College of Cardiology
© 2012 by the American College of Cardiology Foundation
Published by Elsevier Inc.
Vol. 60, No. 22, 2012