Prosthetic mitral valve endocarditis with left atrial dissection.

of rheumatic mitral stenosis 20 years previously. The patient was readmitted for treatment of idiopathic fever. On admission, slight fever (37.2°C), blood pressure of 121/96 mmHg, and a pulse rate of 68 beats/min were recorded. Auscultation of the heart produced a metallic click sound without significant murmur. On blood tests, white blood cell count and serum C-reactive protein were elevated, at 10,200/μl and 4.9 mg/dl, eft atrial (LA) dissection is a fissure extending from the mitral or tricuspid annulus to the interatrial septum or LA wall, creating a new chamber.1 LA dissection is rare but has been reported in approximately 0.8% of patients following mitral valve replacement (MVR).2 MVR was performed in a 72-year-old Japanese man using a 31-mm St. Jude Medical (SJM) prosthetic valve for treatment L