This video tells the story of a 32-year-old patient with an unusual combination of hypertrophic cardiomyopathy, along with aortic and mitral valve endocarditis, who presented late with acute mitral regurgitation and hemoptysis —coughing up blood.

Typically, acute mitral regurgitation presents with hemodynamic instability; however, it can present with extensive infiltrates of the lung, particularly on the right side, and alarming hemoptysis. This occurs as a result of acute pulmonary hypertension, resulting in alveolar hemorrhage that is accompanied by massive hemoptysis and acute respiratory failure.

From a surgical standpoint, this case was particularly challenging due to the patient’s underlying hypertrophic cardiomyopathy, along with the healed —but extensive—endocarditic damage to both the aortic valve and mitral valves. He underwent successful aortic valve repair and mitral valve replacement. He did not require a septal myectomy, as the left ventricular outflow tract (LVOT) gradient was only 4 mmHg at the end of the procedure.

The aortic valve was patched with native pericardium. The anterior mitral leaflet had been completely destroyed from the previous infection, and therefore a mechanical valve was selected for replacement due to the patient’s young age and history of hypertrophic cardiomyopathy.

He was discharged to home on post-operative day 6 on therapeutic warfarin therapy and 81mg aspirin daily.