A Case Report: Marantic Endocarditis in a Patient with Rheumatoid Arthritis for Twenty-Five Years and Surgical Treatment

Marantic endocarditis (ME) is named as endocarditis that occurs because of the deposition of sterile platelets and thrombus in the valve leaflets without any microorganism growth. In this report, our aim is to present the diagnosis and surgical treatment of ME with restricted mobile vegetation in a patient with rheumatoid arthritis (RA) for 25 years. A 55-year-old female patient, who had been followed up for RA for 25 years, had complaints of palpitation and chest pain, and echocardiography revealed a restricted mobile, 1.9×1.7cm irregular mass on the atrial surface of the mitral valve posterior leaflet. Considering infective endocarditis in the preliminary diagnosis, empirical antibiotic and anticoagulation treatment was started. Control TEE on 14th days showed no regression of mass, and the patient was referred for surgery due to mass. The mass adherent on the p3 segment of the posterior leaflet was totally excised. After excision, the posterior leaflet was repaired with an autologous pericardial patch, and ring annuloplasty was performed. No regurgitation was detected in intraoperative TEE. The postoperative period of the patient was completed uneventfully, and the patient was discharged with full recovery. There was no growth in the cultures of the patient, and the pathological evaluation of the excised mass confirmed the diagnosis of ME. ME can be seen rarely, especially in those with chronic autoimmune inflammatory diseases such as RA. Mitral valve repair can be performed by preserving functional segments of the mitral valve such as the leaflet free edge and primary chordae.