2024 Volume 28 Issue 1 Pages 141-145
Löffler's endocarditis is a cardiac complication of hypereosinophilic syndrome. Herein, we report a case of Löffler's endocarditis associated with severe mitral regurgitation (MR).
A 74-year-old woman was brought to the emergency department with chest pain and dyspnea and was diagnosed with congestive heart failure. Initial blood investigations revealed an elevated eosinophil count (3,240/μL), and echocardiography revealed thrombus formation in the left ventricle. The suspected diagnosis was Löffler's endocarditis. Medical treatment with an anticoagulant and steroid was ineffective, and severe MR appeared during the disease course. As MR was refractory to medical treatment, surgical correction was planned. As the degree of mitral valve tethering was mild and the possibility of reversible change to the thrombus could not be ruled out, we decided to first perform left ventricular thrombus removal. However, transesophageal echocardiography after thrombus removal and resumption of self-paced heartbeat revealed residual findings of severe MR. Intraoperative findings showed severe degeneration of the papillary muscles and tendon cords; therefore, the mitral valve was replaced. The results suggest that MR associated with Löffler's endocarditis, characterized by fibrosis and other tissue degeneration, may require valve replacement.
