In descending order of incidence, which (native) cardiac valves are most commonly involved in infective endocarditis? A. mitral > tricuspid > pulmonic > aortic B. mitral > aortic > tricuspid > pulmonic C. tricuspid > mitral > aortic > pulmonic D. aortic > pulmonic > tricuspid > mitral
B. Mitral valve > aortic valve > tricuspid valve > pulmonic valve Infective endocarditis (IE) most commonly involves the left heart, with the mitral valve most commonly affected overall. The predominance of left sided involvement is postulated to be secondary to the higher incidence of structural variance of the mitral/aortic valves, higher left-sided intracardiac pressures, and a higher blood oxygen content. Common structural lesions implicated include mitral valve prolapse, bicuspid aortic valves, and calcific degeneration of the mitral/aortic valves. Endocarditis involving right heart structures is far less common (5-10% of cases) and is primarily associated with intravenous drug use.
Transthoracic echocardiogram: hyperdynamic left ventricular systolic function with an estimated ejection fraction between 65-70%. Severe left atrial enlargement. Moderate aortic regurgitation, severe mitral regurgitation. Mitral valve leaflets thickened. Oscillating, irregular, hyperdense mass on anterior leaflet consistent with vegetation. Intermittent appearance of mobile echodensity primarily in diastole on the upstream (ventricular) aspect of the aortic valve.