Q: Which valve with vegetation in endocarditis has the highest risk of sequelae? 

A) Tricuspid valve
B) Aortic valve
C) Pulmonic valve
D) Anterior mitral leaflet 
E) on papillary muscles


Answer: D

As expected left sided vegetation in endocarditis carries more risk of complications like CVA, ophthalmic complications, ischemia of the extremities or to organs like renal or spleen, PE or even acute MI. But, in comparison to Aortic valve the risk is highest among patients with a vegetation on the anterior mitral leaflet. It is assumed that this is due to broad and abrupt leaflet excursion of the anterior mitral leaflet.



References: 

 1. Bayer AS, Bolger AF, Taubert KA, et al. Diagnosis and management of infective endocarditis and its complications. Circulation 1998; 98:2936. 

2. Rohmann S, Erbel R, Görge G, et al. Clinical relevance of vegetation localization by transoesophageal echocardiography in infective endocarditis. Eur Heart J 1992; 13:446.