Impressive Mitral Valve Aneurysm Following Thickening of the Anterior Leaflet

An 84-year-old man was referred to hospital with heart failure due to complete atrioventricular block. Transthoracic echocardiography (TTE) showed thickening of the anterior leaflet of the mitral valve (Figure A,B). However, the patient had no fever, and his blood cultures were negative. Subsequently, we performed pacemaker implantation, and the postoperative recovery was uneventful without fever. At follow-up 1 month later, a grade III/VI systolic murmur was audible at the apex, and repeat TTE revealed a saccular change in the mitral valve and moderate regurgitation (Figure C,D; Supplementary Movie 1). Transesophageal echocardiography showed a partially perforated mitral valve aneurysm (MVA) of the anterior mitral leaflet (25×31 mm), which exhibited accelerated blood flow within the aneurysm (Figure E,F; Supplementary Movie 2). The blood cultures were negative again, and the patient did not have a fever. He had well-controlled heart failure with diuretics. After 3 months, the patient did not require rehospitalisation for worsening heart failure, and we continued the follow-up carefully.

Figure.

Transthoracic echocardiographs before (A,B: yellow arrowhead indicates thickened mitral valve) and after (C,D) the occurrence of a saccular change. Transesophageal echocardiographs (E,F) show a 25×31-mm aneurysm that is partially perforated with outflow of blood (white arrow, F).

Werner et al reported that MVA is a unique consequence of infective endocarditis (IE) affecting the aortic valve.¹ Our patient presented with neither active infection nor aortic valve changes; however, he had received oral antibiotic treatments for a dry cough at other medical institutes before being referred to us. Healed IE was assumed to be the cause of the sequence of events.

Disclosures

None.

Supplementary Files

Supplementary Movie 1. Transthoracic echocardiography showing the saccular change in the mitral valve and worsening regurgitation.

Supplementary Movie 2. Transesophageal echocardiographic showing the mitral valve aneurysm moving back and forth between the left ventricle and atrium.

Please find supplementary file(s);

http://dx.doi.org/10.1253/circj.CJ-21-0919

Reference

• 1.   Werner ME, Riezebos RK, Kuipers RS. A perforated mitral valve aneurysm: A rare but serious complication of aortic valve endocarditis resulting from a regurgitant jet lesion. Cureus 2020; 12: e11644.