Danijela Trifunovic1,3, Bosiljka Vujisic-Tesic1,3, Vesna Bozic2,Milan Petrovic1,3, Miodrag Ostojic1,3
Departments of 1Cardiology and 2Pathology, University Clinical Centre of Serbia, 3Belgrade School of Medicine, Belgrade, Serbia
Mitral valve aneurysm (MVA) is a rare valve disease. The case is reported of pathologically proven MVA in a 61-year-old diabetic male with chronic alcoholic liver disease who presented with dyspnea and new-onset atrial fibrillation, without clinical elements of current or recent infection. Transthoracic echocardiography revealed a ‘cystic’ formation of the anterior mitral leaflet (AML) with mild mitral regurgitation (MR) and aortic regurgitation (AR) hitting the AML. Transesophageal echocardiography (TEE) showed clearly that the formation on the AML was a valve aneurysm, and depicted the site of aneurysm rupture with an additional jet of MR through the rupture. Following mitral valve replacement, pathology of the excised valve showed chronic bacterial endocarditis with calcified bacterial colonies, myxomatous changes with fibrinoid dissection of lamina fibrosa, and neovascularization of the leaflet. The mechanisms of MVA formation are discussed, together with its potential complications, diagnostic modalities and therapeutic strategies. The present case emphasizes that MVA is often a remnant of endocarditis, even when the latter is clinically silent and undiagnosed.
The importance of chronic AR directed towards the AML as a predisposing condition for MVA formation is also underlined in this case. The superiority of TEE in providing a full exploration of the mitral valve morphology is verified.
Movie 1: Transthoracic echocardiography parasternal long axis view. [Click here to view]
Movie 2: Transthoracic echocardiography apical four chamber view. [Click here to view]
Movie 3: Transesophageal echocardiography four chamber view. [Click here to view]
Movie 4: Transesophageal echocardiography 50º view: site of the rupture. [Click here to view]
Movie 5: Transesophageal echocardiography 90º view: color Doppler. [Click here to view]
The Journal of Heart Valve Disease 2014;23:506-510
|Ruptured Giant Mitral Valve Aneurysm: An Unexpected Finding in a Diabetic Patient with Dyspnea and New-Onset Atrial Fibrillation|
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