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Case Reports in
Cardiology
From the earliest days of medicine to the present, case reports have been a critical
aspect of clinical education and knowledge development. In this comprehensive
volume, Dr.William C. Roberts, a renowned expert in the eld, explores the rich
history and ongoing importance of case reports in cardiology.
Through engaging and insightful analysis, the book demonstrates how case
reports have provided physicians with crucial insights into rare diseases, complex
conditions, and ground-breaking treatments. Drawing on a vast range of sources,
from seminal manuscripts to cutting-edge journals, it presents a unique perspective
on the role of case reports in medical education and practice of valvular heart
disease and analogous cardiac morbidities, including carcinoid heart disease with
a rich coverage of heart valve bioprostheses. It underscores how case reports can be
used to enhance diagnostic accuracy, identify new treatment options, and promote
innovation in the eld. In addition, the book provides valuable insights into the
process of writing and publishing case reports, including tips for young physicians
looking to break into the eld.
The book will be an indispensable guide to the history, practice, and ongoing
signicance of case reports for medical students, physicians, and researchers alike.
KEY FEATURES
◼
Provides a rich repository of diverse case reports in cardiology published by the
editor and his colleagues over 61years
◼
Features 65 clinical case studies related to Valvular Heart Disease useful for
medical students and practicing cardiologists
◼
It is a valuable resource for young physicians seeking to establish a foothold in
medical research and academics
Case Reports in Cardiology
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Series Editor
William C. Roberts, MD
Baylor Heart and Vascular Institute, Baylor University Medical Center, Dallas
Case Reports in Cardiology: Congenital Heart Disease
Edited by Dr.William C. Roberts, MD
Case Reports in Cardiology: Valvular Heart Disease
Edited by Dr.William C. Roberts, MD
Case Reports in Cardiology: Coronary Heart Disease and Hyperlipidemia
Edited by Dr.William C. Roberts, MD
Case Reports in Cardiology: Cardiomyopathy
Edited by Dr.William C. Roberts, MD
Case Reports in Cardiology: Cardiac Neoplasm
Edited by Dr.William C. Roberts, MD
Case Reports in Cardiology: Cardiovascular Diseases with a Focus on Aorta
Edited by Dr.William C. Roberts, MD
For more information on this series, please visit https://www.routledge.com/
Case-Reports-in-Cardiology/book-series/CRIC
Case Reports in Cardiology
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Valvular Heart Disease
Edited by
William C. Roberts, MD
Designed cover image: Shutterstock
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First edition published 2024
by CRC Press
6000 Broken Sound Parkway NW, Suite 300, Boca Raton, FL 33487–2742
and by CRC Press
4 Park Square, Milton Park, Abingdon, Oxon, OX14 4RN
CRC Press is an imprint of Taylor& Francis Group, LLC
© 2024 selection and editorial matter, William C. Roberts; individual chapters, the contributors
This book contains information obtained from authentic and highly regarded sources. While
all reasonable efforts have been made to publish reliable data and information, neither the
author[s] nor the publisher can accept any legal responsibility or liability for any errors or
omissions that may be made. The publishers wish to make clear that any views or opinions
expressed in this book by individual editors, authors or contributors are personal to them and
do not necessarily reect the views/opinions of the publishers. The information or guidance
contained in this book is intended for use by medical, scientic or health-care professionals
and is provided strictly as a supplement to the medical or other professional’s own judgement,
their knowledge of the patient’s medical history, relevant manufacturer’s instructions and the
appropriate best practice guidelines. Because of the rapid advances in medical science, any
information or advice on dosages, procedures or diagnoses should be independently veried.
The reader is strongly urged to consult the relevant national drug formulary and the drug
companies’ and device or material manufacturers’ printed instructions, and their websites,
before administering or utilizing any of the drugs, devices or materials mentioned in this
book. This book does not indicate whether a particular treatment is appropriate or suitable for
a particular individual. Ultimately it is the sole responsibility of the medical professional to
make his or her own professional judgements, so as to advise and treat patients appropriately.
The authors and publishers have also attempted to trace the copyright holders of all material
reproduced in this publication and apologize to copyright holders if permission to publish in
this form has not been obtained. If any copyright material has not been acknowledged please
write and let us know so we may rectify in any future reprint.
Except as permitted under U.S. Copyright Law, no part of this book may be reprinted,
reproduced, transmitted, or utilized in any form by any electronic, mechanical, or other means,
now known or hereafter invented, including photocopying, microlming, and recording, or in
any information storage or retrieval system, without written permission from the publishers.
For permission to photocopy or use material electronically from this work, access www.
copyright.com or contact the Copyright Clearance Center, Inc. (CCC), 222 Rosewood Drive,
Danvers, MA 01923, 978-750-8400. For works that are not available on CCC please contact
mpkbookspermissions@tandf.co.uk.
Trademark notice: Product or corporate names may be trademarks or registered trademarks and
are used only for identication and explanation without intent to infringe.
ISBN: 978-1-032-52937-0 (hbk)
ISBN: 978-1-032-52936-3 (pbk)
ISBN: 978-1-003-40928-1 (ebk)
DOI: 10.1201/9781003409281
Typeset in Palatino LT Std
by Apex CoVantage, LLC
William Clifford Roberts, MD [1932–2023]
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A Remembrance
As a cardiac surgical associate at the NIH in Bethesda for 2 years, I attended my
father’s Monday conference regularly. There was a case of a healed traumatic aortic
rupture. The fellow discovered that the patient was in a motor vehicle accident
“several years before death.” To this fellow, WCR said, “Write this case up and have
it on my desk by Friday.” He added, “It takes about as long to write a brief report
as it does to write up the chart. Know the case precisely before going to the library
to search the literature.” He told the fellow to put the aorta in his pocket to remind
him what it looked like. “This is a single task, a single mission.” What to search for
in the library? “Are there any cases of healed traumatic aneurysm of the descending
thoracic aorta.” In 30 years, WCR had seen only 1 other, who died 7 days later, not
7 years. This was 1989, of course, before the ubiquitous use of CT scans.
The material for his case reports was this weekly conference in cardiovascular
pathology over 6 decades. During these conferences, WCR would personally
examine each surgical and autopsy cardiovascular specimen that was submitted—a
heart or valve or aorta—and a chart would be created for each patient. He would
typically examine each specimen as “an unknown.” To him it was a provocative
way to conduct the conference. He urged his students and residents and fellows to
“remember one thing about each case.” To him that was >600 “new things” a year.
He believed that studying the case at hand was better than general reading.
In a personal review of his own publications, William Clifford Roberts, MD
(WCR) listed 269 case reports out of a total of 1784 publications over a 60-year period,
1961–2022. This sheer number of case reports by one physician in cardiovascular
disease is perhaps a record in the eld.
As an editor in chief of 2 medical journals, he carefully considered the value of
case reports:
Usually, case reports have only 1 point, and information not pertinent to that
point is unnecessary. Indeed, unnecessary words and nonessential details
actually prevent clear focus on the patient. Thus, these “Brief Reports” must
be brief—no more than 2 or 3 double-spaced typed pages with few references.
Reports only 1 page long will be favored over those 3 pages long. Pertinent
illustrations may be the dominant element in conveying the message...Brief
Reports require clear thinking. Each word must count.
In nearly every case report of WCR, there is an illustration or photograph. WCR
preferred “drawings not words.” He would say, “There is nothing more important
than absolutely perfect photographs.” In his rst 20 years at NIH, he spent every
Tuesday and Thursday morning from 9am to noon with a photographer. He believed
the subject should occupy “85% of the frame.”
WCR graduated from Southern Methodist University (1954) and Emory
University School of Medicine (1958), then had 6 years of residency training. For
the next 60 years (1964–2023), he focused exclusively on cardiovascular pathology.
The rst 30 years were spent at NIH in Bethesda and the second 30 years at Baylor
University Medical Center in Dallas. He held his weekly conference past 90 years
of age.
My younger brother, John David Roberts, observed that WCR was “an intense
scholar, but also a loving person. He had both qualities. He was loved for the person,
not the accomplishments. One would never know he was a physician in daily
interactions. He was satised to be unknown. Though in the Public Health Service
for 30 years, he never wore the Navy uniform, even when it was recommended
at NIH. As a father he required respect, which included “Yes Sir” and “No Sir.”
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Manners were important to him, especially at the table for the evening meal, where
each of his children was asked to express what he or she learned that day.”
He will be remembered by his family not only for his contribution to the eld
of medicine, but for his hungry intellect, his indominable work ethic, his high
standards, and his loyalty to loved ones.
Charles Stewart Roberts, MD
October 1, 2023
Contents
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Preface . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xiii
About the Editor
Introduction
Case 8. Roberts WC, Rabson AS. Focal Glomerular Lesions in Fungal
Endocarditis. Ann Intern Med. 1962;56(4):610–618 . . . . . . . . . . . . . . . . . . . . . 1
Case 14. Levine RJ, Roberts WC, Morrow AG. Traumatic Aortic
Regurgitation. Am J Cardiol. 1962;10(5):752–763
Case 26. Friedman RM, Roberts WC. Myocardial Embolus—A
Complication of Mitral Valvulotomy. N Engl J Med.
1965;272(5):251–252
Case 32. Roberts WC, Mason DT, Wright LD Jr. The Nondistensible Right
Atrium of Carcinoid Disease of the Heart. Am J Clin Pathol.
1965;44(6):627–631
Case 35. Berard CW, Roberts WC, Kahler RL. Pulmonary Arteriovenous
Fistula and Rheumatic Cardiac Disease. Am Heart J.
1966;71(3):390–392
Case 38. Brawley RK, Roberts WC, Morrow AG. Intestinal Infarction
Resulting from Nonobstructive Mesenteric Arterial Insufciency.
With a Note on Hepatic Hypoglycemia as a Possible Aid in
Diagnosis. Arch Surg. 1966;92(3):374–378
Case 56. Roberts WC, Berard CVV, Braunwald NS. Roentgenogram of the
Month. Dis Chest. 1967;51(4):439–440
Case 65. Carpenter DF, Golden A, Roberts WC. Quadrivalvular
Rheumatoid Heart Disease Associated with Left Bundle Branch
Block. Am J Med. 1967;43(6):922–929.
Case 78. Roberts WC, Kehoe JA, Carpenter DF, Golden A. Cardiac Valvular
Lesions in Rheumatoid Arthritis. Arch Intern Med. 1968;122(2):141–146
Case 89. Glancy DL, Massumi RA, Roberts WC. Fatal Acute Rheumatic
Fever in Childhood Despite Corticosteroid Therapy. A Note
on the Spectrum of Childhood Rheumatic Fever. Am Heart J.
1969;77(4):534–537
Case 97. Ewy GA, Lotz M, Geraghty M, Marcus FI, Roberts WC. Clinical
Pathologic Conference. Am Heart J. 1969;78(2):259–265
Case 114. Roberts WC, Levinson GE, Morrow AG. Lethal Ball Variance
in the Starr-Edwards Prosthetic Mitral Valve. Arch Intern Med.
1970;126(3):517–521
Case 156. Shepherd RL, Glancy DL, Stinson EB, Roberts WC. Hemodynamic
Conrmation of Obstruction to Left Ventricular Inow by
a Caged-Ball Prosthetic Mitral Valve. Case Report. J Thorac
Cardiovasc Surg. 1973;65(2):252–254
Case 182. Roberts WC, Hollingsworth JF, Bulkley BH, Jaffe RB, Epstein
SE, Stinson EB. Combined Mitral and Aortic Regurgitation in
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xv
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xvii
. . . . . . . . . . . . . . . . . . . . . . 11
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. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35
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. . . 59
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 67
. . . . . . . . . . . . . . . 72
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 80
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 85
*Note: Cases are numbered based on their number in WCR’s CV.
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CONTENTS
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Ankylosing Spondylitis. Angiographic and Anatomic Features.
Am J Med. 1974;56(2):237–243
Case 231. Hammer WJ, Hearne MJ, Roberts WC. Cocking of a Poppet-Disc
Prosthesis in the Aortic Position. A Cause of Intermittent Aortic
Regurgitation. J Thorac Cardiovasc Surg. 1976;71(2):259–261
Case 243. McReynolds RA, Ali N, Cuadra M, Roberts WC. Combined Acute
Rheumatic Fever and Congenitally Bicuspid Aortic Valve: A
Hitherto Unconrmed Combination. Chest. 1976;70(1):98–100
Case 267. Arnett EN, Kastl DG, Garvin AJ, Roberts WC. Clinical Pathologic
Conference: A Conversation on Prosthetic Valve Endocarditis. Am
Heart J. 1977;93(4):511–517
Case 274. Jones AA, Otis JB, Fletcher GF, Roberts WC. A Hitherto
Undescribed Cause of Prosthetic Mitral Valve Obstruction.
J Thorac Cardiovasc Surg. 1977;74(1):116–117
Case 301. Breyer RH, Arnett EN, Spray TL, Roberts WC. Prosthetic-Valve
Endocarditis Due to Listeria Monocytogenes. Am J Clin Pathol.
1978;69(2):186 –187
Case 369. Waller BF, Reis RL, McIntosh CL, Epstein SE, Roberts WC. Marfan
Cardiovascular Disease Without the Marfan Syndrome. Fusiform
Ascending Aortic Aneurysm with Aortic and Mitral Valve
Regurgitation. Chest. 1980;77(4):533–540
Case 402. Davis WA, Isner JM, Bracey AW, Roberts WC, Garagusi VF.
Disseminated Petriellidium Boydii and Pacemaker Endocarditis.
Am J Med. 1980;69(6):929–932
Case 413. Ishihara T, Ferrans VJ, Jones M, Cabin HS, Roberts WC. Calcic
Deposits Developing in a Bovine Pericardial Bioprosthetic Valve 3
Days After Implantation. Circulation. 1981;63(3):718–723
Case 458. Borkon AM, McIntosh CL, Jones M, Roberts WC, Morrow AG.
Inward Stent-Post Bending of a Porcine Bioprosthesis in the Mitral
Position: Cause of Bioprosthetic Dysfunction. J Thorac Cardiovasc
Surg. 1982;83(1):105–107
Case 491. McManus BM, Katz NM, Blackbourne BD, Gottdiener JS, Wallace
RB, Roberts WC. Acquired Cor Triatriatum (Left Ventricular False
Aneurysm). Complication of Active Infective Endocarditis of the
Aortic Valve with Ring Abscess Treated by Valve Replacement.
Am Heart J. 1982;104(2 Pt 1):312–314
Case 497. Waller BF, Kishel JC, Roberts WC. Severe Aortic Regurgitation
from Systemic Hypertension. Chest. 1982;82(3):365–368
Case 523. Roberts WC, Arnett EN, Aisner SC, Techlenberg P. Aortic Valve
Stenosis and Left Ventricular Apical Aneurysm and/or Rupture.
Real or Potential Complications of Persistent Left Ventricular
Systolic Hypertension After Acute Myocardial Infarction. Am
Heart J. 1983;105(3):513–514
Case 531. Ferrans VJ, McManus B, Roberts WC. Cholesteryl Ester Crystals in
A Porcine Aortic Valvular Bioprosthesis Implanted for Eight Years.
Chest. 1983;83(4):698–701.
Case 543. Silver MA, Orenburg PR, Roberts WC. Severe Mitral
Regurgitation Immediately After Mitral Valve Replacement
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .116
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 88
. . . . . . . . . . . . 96
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. . . . . . . . . . . . . . . . . . . . . . . . . .114
. . . . . . . . . . . . . . . . . . . . . . . . . . 119
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 130
. . . . . . . . . . . . 136
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 144
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 148
. . . . . . . . . . . . . 152
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 158
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 160
viii
CONTENTS
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with a Parietal Pericardial Bovine Bioprosthesis. Am J Cardiol.
1983;52(1):218–219
Case 633. Lester WM, Roberts WC. Fatal Bioprosthetic Regurgitation
Immediately After Mitral and Tricuspid Valve Replacements with
Ionescu-Shiley Bioprostheses. Am J Cardiol. 1985;55(5):590–592
Case 724. Barbour DJ, McIntosh CL, Roberts WC. Extensive Calcication
of a Bioprosthesis in the Tricuspid Valve Position and Minimal
Calcication of a Simultaneously Implanted Bioprosthesis in the
Mitral Valve Position. Am J Cardiol. 1987;59(1):179–180
Case 788. Potkin BN, McIntosh CL, Cannon RO III, Roberts WC.
Bioprostheses in Tricuspid and Mitral Valve Positions for 100
Months with Heavier Calcic Deposits on the Left-Sided Valve
Followed by New Bioprostheses in Both Positions for 95 Months
with Heavier Calcic Deposits on the Right-Sided Valve. Am J
Cardiol. 1988;61(11):947–949
Case 806. Mann JM, Roberts WC. “Quadricuspidization” of a Previously
Three-Cuspid Aortic Valve. Am Heart J. 1988;116(3):889–890
Case 811. Kalan JM, McIntosh CL, Bonow RO, Roberts WC. Development of
Severe Stenosis in a Previously Purely Regurgitant, Congenitally
Bicuspid Aortic Valve. Am J Cardiol. 1988;62(13):988–989
Case 840. Dollar AL, Pierre-Louis M-L, McIntosh CL, Roberts WC.
Extensive Multifocal Myocardial Infarcts from Cloth Emboli
After Replacement of Mitral and Aortic Valves with ClothCovered, Caged-Ball Prostheses. Am J Cardiol. 1989;64(5):410–412
Case 876. Roberts CS, Roberts WC. Huge, Unattached Left Atrial Thrombus
in Mitral Stenosis. Clin Cardiol. 1990;13(4):295–297
Case 898. Kragel AH, Lapa JA, Roberts WC. Cardiovascular Findings in
Alkaptonuric Ochronosis. Am Heart J. 1990;120(6 Pt 1):1460–1463
Case 903. Roberts WC, Dollar AL. Extreme Obstruction to Left Ventricular
Outow by a Bioprosthesis in the Mitral Valve Position. Am Heart
J. 1991;121(2 Pt 1):607–608
Case 919. Klues HG, Statler LS, Wallace RB, Roberts WC. Massive
Calcication of a Porcine Bioprosthesis in the Aortic Valve
Position and the Role of Calcium Supplements. Am Heart J.
1991;121(6 Pt 1):1829–1831
Case 1167. Lander SR, Taylor JE, Roberts WC. Congenitally Bicuspid Stenotic
Aortic Valves in Octogenarians. Am J Geriatr Cardiol.
1999;8(6):304–306
Case 1306. Grayburn PA, Hamman BL, Roberts WC. Severe Late (16 Years)
Dysfunction of a Bioprosthesis in the Mitral Valve Position
Without Dysfunction of a Bioprosthesis in the Aortic Valve
Position. Proc Bayl Univ Med Cent. 2004;17(2):214
Case 1335. Farooq H, Grayburn P, Roberts WC. Severe Regurgitation
Immediately After Replacement of a Dysfunctional Bioprosthesis
in the Mitral Valve Position. Am J Cardiol. 2005;95(5):703–704
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 166
. . . . . . 168
. . . . . . . . . . . . . . 171
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. . . . . . . . 177
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. . . . . . . . . . . . . . . . . 186
. . . . 190
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. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 197
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 200
. . . . . . . . . . . . . . . . . . 203
. . . . . . . 205
. . . 182
ix
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