Rheumatoid Nodule Causing Perforation of Anterior Mitral Leaflet and Severe Mitral Regurgitation: A Rare Case Report

Jayanth Koneru, Matthew Cholankeril, Priyank Shah, Fayez Shamoon, Hartaj Virk, Mahesh Bikkina

Seton Hall Cardiology Fellowship Program, St. Joseph’s Regional Medical Center, Paterson, USA.
Seton Hall Cardiology Fellowship Program, St. Michael’s Medical Center, Newark, USA.
Seton Hall Internal Medicine Program, St. Michael’s Medical Center, Newark, USA.

DOI: 10.4236/wjcd.2014.44023                

Abstract

Rheumatoid arthritis (RA) is a systemic disorder that is chronic in nature and difficult to treat. RA presents in many variants. Here we present an interesting case only seldom described before. Our patient presented to emergency room with acute shortness of breath and was seen to have acute pulmonary edema. Patient later had urgent echocardiography which revealed severe mitral regurgitation from ruptured anterior leaflet. Patient was taken for heart valve replacement and was found to have RA nodule on ruptured leaflet. There are cases involving aortic valve but to our knowledge there are no reports of RA nodule on mitral leaflet.

Keywords

Rheumatoid Arthritis, Rheumatoid Nodule, Heart Failure, Mitral Valve Replacement

Conflicts of Interest

The authors declare no conflicts of interest.

References

[1]	Turiel, M., Sitia, S. and Atzeni, F. (2010) The Heart in Rheumatoid Arthritis. Autoimmunity Reviews, 9, 414-418. http://dx.doi.org/10.1016/j.autrev.2009.11.002
[2]	Roldan, C., DeLong, C. and Qualls, C. (2007) Characterization of Valvular Heart Disease in Rheumatoid Arthritis by Transesophageal Echocardiography and Clinical Correlates. The American Journal of Cardiology, 100, 496-502.
[3]	Arakawa, K., Yamazawa, M. and Morita, Y. (2005) Giant Rheumatoid Nodule Causing Simultaneous Atrio Ventricular and Severe Mitral Regurgitation: A Case Report. Journal of Cardiology, 46, 77-83.
[4]	Giladi, H., Sukenik, S. and Flusser, D. (2004) A Rare Case of Enterobacter Endocarditis Superimposed on a Mitral Valve Rheumatoid Nodule. Journal of Clinical Rheumatology, 31, 1001-1003.
[5]	Longo, M. and Remetz, M. (1998) Cardiovascular Manifestations of Systemic Autoimmune Diseases. Clinics in Chest Medicine, 19, 793-807. http://dx.doi.org/10.1016/S0272-5231(05)70117-9
[6]	Ojeda, V.J., Stuckey, B.G. and Owca, E.T. (1986) Cardiac Rheumatoid Nodules. Medical Journal of Australia, 144, 92-93.
[7]	Guedes, C., Bianchi, F.P. and Cormier, B. (2001) Cardiac Manifestations of Rheumatoid Arthritis: A Case Control Transesophageal Echocardiography Study in 30 Patients. Arthritis Care & Research, 45, 129-135. http://dx.doi.org/10.1002/1529-0131(200104)45:2<129::AID-ANR164>3.0.CO;2-K
[8]	Chand, E.M., Freant, L.J. and Rubin, J.W. (1999) Aortic Valve Rheumatoid Nodules Producing Clinical Aortic Regurgitation and a Review of the Literature. Cardiovascular Pathology, 8, 333-338. http://dx.doi.org/10.1016/S1054-8807(99)00024-1
[9]	Mounct, F.S., Soula, P. and Concina, P. (1997) A Rare Case of Embolizing Cardiac Tumor: Rheumatoid Nodule of the Mitral Valve. Journal of Heart Valve Disease, 6, 77-78.
[10]	Didry, C., Combe, B. and Flaisler, F. (1992) Rheumatoid Aortic Insufficiencies: Severity of the Prognosis. Rev Rhum Mal Osteoartic, 59, 571-576.
[11]	Levine, A.J., Dimitri, W.R. and Bonser, R.S. (1999) Aortic Regurgitation in Rheumatoid Arthritis Necessitating Aortic Valve Replacement. European Journal of Cardiothoracic Surgery, 15, 213-214. http://dx.doi.org/10.1016/S1010-7940(98)00294-2
[12]	Iveson, J.M., Thadani, U. and Ionescu, M. (1975) Aortic Valve Incompetence and Replacement in Rheumatoid Arthritis. Annals of Rheumatic Disease, 34, 312-320. http://dx.doi.org/10.1136/ard.34.4.312