# A Rare Case of Bivalvular Infective Endocarditis With Left Atrial Mural Endocarditis

## TL;DR

A rare case of heart infection involving both heart valves and the left atrium is reported, highlighting the need for multidisciplinary care.

## Contribution

This case highlights the rare occurrence of bivalvular infective endocarditis with left atrial mural endocarditis and the importance of multidisciplinary evaluation.

## Key findings

- A 61-year-old male presented with bivalvular infective endocarditis and left atrial mural endocarditis.
- Multidisciplinary evaluation is recommended for accurate diagnosis and management of mural endocarditis.
- Surgical intervention and targeted antibiotic therapy were effective in treating the condition.

## Abstract

Infective endocarditis (IE) is a life-threatening cardiac infection usually associated with cardiac valves. Left atrial (LA) mural endocarditis is rarely seen and occurs in isolation or in conjunction with mitral valve endocarditis. We present a case of a 61-year-old male with no prior cardiac history who presented with melena and fevers. Blood cultures were positive for Enterococcus faecalis. Transesophageal echocardiogram (TEE) demonstrated aortic and mitral valve vegetations with several small echo densities present on the left atrial wall. These findings were further assessed with a computed tomography angiogram of the heart and cardiac magnetic resonance imaging Ti600 sequence. The patient was treated with intravenous antibiotics and underwent aortic and mitral valve replacement with resection of numerous small fungating masses on the left atrium. There are currently no formal guidelines in place for managing mural endocarditis. However, conducting a multidisciplinary evaluation by an endocarditis team could aid in achieving earlier and more precise diagnoses of the underlying condition and its complications. This approach could also ensure consistent antibiotic therapy and appropriate timing for surgical intervention.