"Grey Zone" Patterns of Unexplained Endocarditis: Still a Challenge for Clinical Decision Making

Antonio Grimaldi, Maurizio Taramasso, Francesco Maisano, Giovanni La Canna, Maria Grazia Pala, Stefano Benussi, Giorgio Viganò, Ottavio Alfieri

Research output: Contribution to journalArticlepeer-review


The authors report two cases of unexplained active inflammatory endocarditis with totally different clinical presentations. The patients had undergone previous mitral repair surgery and were referred for multiple soft mobile masses on the mitral ring without clinical or laboratory signs of endocarditis. Serologic screening and blood culture results were negative, including those for specific fastidious bacteria, as well as immunologic tests to rule out "nonbacterial thrombotic endocarditis." Before new surgery, both patients were treated with long-term antibiotic and anticoagulant therapy, with no significant changes in clinical setting and echocardiographic patterns. In neither case was it possible to characterize a specific microorganism: the intraoperative findings were highly evocative of active endocarditis with a macroscopic infiltration of the mitral ring, and culture results from surgical material and valvular tissue were negative.

Original languageEnglish
JournalJournal of the American Society of Echocardiography
Issue number2
Publication statusPublished - Feb 2010


  • Acute endocarditis
  • Mitral valve repair
  • Three-dimensional echocardiography

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Radiology Nuclear Medicine and imaging


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