Our Patient's Hospital Course

During the first three days in the hospital, in addition to antibiotics, nitroprusside was continued and our patient's fever declined. Her oxygenation improved and she had less dyspnea.

Most patients with acute, severe mitral regurgitation tolerate their condition poorly. Our patient's mitral regurgitation was persistent and severe, as evidenced by continued dyspnea at rest, high pulmonary capillary wedge pressure and low cardiac output, despite appropriate medical therapy. Mitral valve surgery is now indicated to repair the mitral valve if at all possible. If not, mitral valve replacement should be carried out.

Left ventricular angiography was not performed prior to surgery, because of the danger of dislodging the vegetation.