Anterior mitral valve aneurysm: a rare sequelae of aortic valve endocarditis

Mitral valve aneurysms: echocardiographic characteristics, formation mechanisms, and patient outcomes

Background

The accurate etiology of mitral valve aneurysm (MVA) formation is not completely understood, and the most effective management approach for this condition remains controversial.

Methods

We retrospectively analyzed 20 MVA patients who underwent either surgical interventions or conservative follow-ups at the Zhongnan Hospital of Wuhan University between 2017 and 2021. We examined their clinical, echocardiographic, and surgical records and tracked their long-term outcomes.

Results

Of the 20 patients, 12 were diagnosed with MVA using transthoracic echocardiography, seven required additional transesophageal echocardiography for a more definitive diagnosis, and one child was diagnosed during surgery. In all these patients, the MVAs were detected in the anterior mitral leaflet. We found that 15 patients (75%) were associated with infective endocarditis (IE), whereas the remaining patients were associated with bicuspid aortic valve and moderate aortic regurgitation (AR) and mild aortic stenosis (5%), congenital heart disease (5%), elderly calcified valvular disease (5%), mitral valve prolapse (5%), and unknown reasons (5%). Of the 17 patients who underwent hospital surgical interventions, two died due to severe cardiac events. The remaining 15 patients had successful surgeries and were followed up for an average of 13.0 ± 1.8 months. We observed an improvement in their New York Heart Association functional class and mitral regurgitation and AR degrees (P-value < 0.001). During follow-up, only one infant had an increased left ventricular end-diastolic diameter and left ventricular end-systolic diameter, whereas the remaining 14 patients had decreased values (P < 0.001). In addition, none of the three conservatively managed patients experienced disease progression during the 7-24 months of follow-up.

Conclusions

We recommend using echocardiography as a highly sensitive method for MVA diagnosis. Although most cases are associated with IE or AR, certain cases still require further study to determine their causes. A prompt diagnosis of MVA in patients using echocardiography can aid in its timely management.

Aneurysmal and obstructive lesions of the left ventricular outflow: evaluation on multidetector computed tomography angiography

The left ventricular outflow is an anatomically complex region situated between the anterior leaflet of the mitral valve and the left ventricular aspect of the muscular and membranous interventricular septum. It gives rise to the aorta, provides support to the aortic valvular cusps, and houses important components of the conduction system. The left ventricular outflow handles high pressures and pressure variations and is subsequently affected by a variety of aetio-pathological conditions. Diseases involving the left ventricular outflow can be intraluminal, mural, or extramural, and the consequent complications of the lesions can be local, loco-regional, or even systemic. Appropriate evaluation requires comprehensive multimodality imaging with each modality contributing to assessment of different aspects of diagnosis, lesion characterization, local extension, prognostication for systemic complications and mortality, and the decision for the approach and type of intervention and aggressive follow-up in case non-interventional management is decided. In this review, we briefly describe the relevant anatomy and the gamut of structural abnormalities pertaining to the left ventricular outflow on multidetector computed tomography angiography.

Mitral valve leaflet diverticulum with vegetation-a rare complication in rheumatic heart disease

Diverticulum of mitral leaflet is a rare complication, which is recognized by its central clearing with characteristic diastolic collapse and systolic expansion on echocardiogram. It is found to be commonly associated with infective endocarditis while various other mechanisms of its formation have been suggested. The present case with an underlying history of rheumatic heart disease complicated by infective endocarditis well demonstrates the formation of mitral leaflet diverticulum and its possible complications. Surgical findings revealed diverticulum of the anterior mitral leaflet, and the patient underwent double valve replacement.

Minimally invasive surgical repair of accessory mitral valve tissue: A case report

INTRODUCTION

Accessory mitral valve tissue is a rare congenital disease of the mitral valve. It is usually associated with other cardiac malformations and/or left ventricular outflow tract obstruction. More than 2/3 of patients were diagnosed in their childhood. Treatment can be conservative or surgical. The suitable timing for surgery remains controversial, some authors suggest early intervention to prevent devastating complications.

CASE REPORT

We report a case of an adult patient with accessory mitral valve tissue causing left ventricular outflow tract obstruction, who was treated surgically via the right minithoracotomy.

Unusual Lesions of the Mitral Valve: Two Different Conditions with the Same Imaging Findings

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Mitral valve (MV) aneurysms are unusual lesions, its incidence is 0.02% to 0.29%.

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Most cases of MV aneurysms are a complication of aortic valve endocarditis.

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Direct Infection of MV leaflets and degenerative lesions could cause a MV aneurysms.

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MV aneurysms are rarely surgical complication, however, it should be kept in mind.