Native mitral valve endocarditis masquerading as ST-segment elevation myocardial infarction

Post-aspiration thrombectomy, thrombolysis in myocardial infarction (TIMI) 3 coronary flow was restored and intravascular ultrasound (IVUS) demonstrated no significant underlying coronary atheroma. Mitral valve IE is associated with a higher risk of embolic events, especially when the anterior mitral leaflet is involved.2 The most common coronary involved in coronary embolism is the LAD artery, which has a less acute course when compared with the right coronary (RCA) and the left circumflex (LCX) arteries.2,5,6 During acute management of embolic ST-segment elevation myocardial infarction due to infective endocarditis, aspiration thrombectomy is preferred over the use of thrombolytic agents as there is an increased risk of intracerebral haemorrhage due to mycotic aneurysms and embolic strokes.7,8 The mental status of a patient should be monitored closely and early cerebral imaging should be performed to evaluate for intracranial complications. The use of intracoronary imaging-guided interventions (eg intravascular ultrasound or optical coherence tomography) may be useful in these situations. * Timing of surgical intervention in native valve infective endocarditis is delicately balanced between the need to achieve a sterile surgical field and the risk of haemodynamic deterioration and/or septic embolism. * A close multidisciplinary collaboration approach (which may include interventional cardiologists, cardiac imaging specialists, infectious disease specialists, neurosurgeons and cardiothoracic surgeons) is essential to achieve timely and appropriate clinical management in cases of complicated infective endocarditis.