Repair for mitral valve aneurysm using autologous pericardium: a case of our experience

Severe mitral regurgitation due to mitral leaflet aneurysm diagnosed by three-dimensional transesophageal echocardiography: a case report

Background

A small mitral valve aneurysm (MVA) presenting as severe mitral regurgitation (MR) is uncommon.

Case presentation

A 47-year-old man with a history of hypertension complained of exertional chest discomfort. A transthoracic echocardiogram (TTE) revealed the presence of MR and prolapse of the posterior leaflet. A 6-mm in diameter MVA, not clearly visualized by TTE, was detected on the posterior leaflet on a three-dimensional (3D) transesophageal echocardiography (TEE). The patient underwent uncomplicated triangular resection of P2 and mitral valve annuloplasty, and was discharged from postoperative rehabilitation, 2 weeks after the operation. Histopathology of the excised leaflet showed myxomatous changes without infective vegetation or signs of rheumatic heart disease.

Conclusions

A small, isolated MVA is a cause of severe MR, which might be overlooked and, therefore, managed belatedly. 3D TEE was helpful in imaging its morphologic details.

Electronic supplementary material

The online version of this article (doi:10.1186/s12872-016-0413-1) contains supplementary material, which is available to authorized users.

Large mitral valve aneurysm with infective endocarditis

A 63-year-old man with infective endocarditis (IE) was admitted to our hospital after experiencing acute heart failure. A two-dimensional transthoracic and transesophageal echocardiography revealed vegetation attached to both aortic and mitral valves, a very large mitral valve aneurysm, a severe mitral regurgitation jet issuing from a mitral valve perforation and severe aortic regurgitation. Three days after admission, both the aortic and mitral valves were replaced. The patient received antibiotic therapy for 6 weeks postoperatively and recovered with no neurological complications. Although the patient was discharged without recurrence of IE, his transthoracic and transesophageal echocardiography showed periprosthetic mitral regurgitation, requiring him to receive close follow-up monitoring. This case report exemplifies the rather unusual, but important, complications of aortic valve IE, and suggests some suitable forms of intervention.