Lyme Disease—An Unusual Cause of a Mitral Valve Endocarditis

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Lyme Disease—An Unusual Cause of a Mitral Valve Endocarditis Benish Fatima, MD, M. Rizwan Sohail, MD, Hartzell V. Schaff, MD Mayo Clinic Proceedings: Innovations, Quality & Outcomes Volume 2, Issue 4, Pages 398-401 (December 2018) DOI: 10.1016/j.mayocpiqo.2018.09.003 Copyright © 2018 Mayo Foundation for Medical Education and Research Terms and Conditions

Figure 1 A, Intraoperative prebypass TEE at initial mitral valve repair. The arrow on the left panel points to a large perforation in the anterior leaflet of the mitral valve. The right panel shows mitral regurgitation through mitral valve perforation. B, Postbypass TEE after initial mitral valve repair. The arrow on the left panel points to the autologous patch repair of the anterior leaflet of the mitral valve. There was no residual mitral regurgitation as seen in the right panel. TEE = transesophageal echocardiography. Mayo Clinic Proceedings: Innovations, Quality & Outcomes 2018 2, 398-401DOI: (10.1016/j.mayocpiqo.2018.09.003) Copyright © 2018 Mayo Foundation for Medical Education and Research Terms and Conditions

Figure 2 The “Two-tier Testing Decision Tree” describes the steps required to properly test for Lyme disease by the Centers for Disease Control and Prevention. Mayo Clinic Proceedings: Innovations, Quality & Outcomes 2018 2, 398-401DOI: (10.1016/j.mayocpiqo.2018.09.003) Copyright © 2018 Mayo Foundation for Medical Education and Research Terms and Conditions

Figure 3 A, Intraoperative prebypass transesophageal echocardiography at redo mitral valve repair. The arrow on the left panel points to a large perforation in the anterior leaflet of the mitral valve. The right panel shows mitral regurgitation through mitral valve perforation. B, Postbypass transesophageal echocardiography after redo mitral valve repair. The arrow on the left panel points to re-repair after resuturing a patch to the anterior leaflet of the mitral valve. There was only trivial residual mitral regurgitation as seen in the right panel. Mayo Clinic Proceedings: Innovations, Quality & Outcomes 2018 2, 398-401DOI: (10.1016/j.mayocpiqo.2018.09.003) Copyright © 2018 Mayo Foundation for Medical Education and Research Terms and Conditions