Mitral stenosis and cardiogenic shock from an obstructive abscess of the mitral annulus.

A 48-year-old female hemodialysis patient with gram-positive mitral endocarditis developed progressive hemodynamic collapse. Echocardiography revealed a mitral annular abscess, which expanded rapidly due to connection with and pressure from the left ventricle. The mitral annular abscess had enlarged sufficiently to obstruct the mitral orifice, resulting in acute cardiogenic shock. The patient underwent and survived emergency surgical repair, and remained well on follow-up.