Clinical and echocardiographic evaluation of mitral valve aneurysms: a retrospective, single center study

Abstract

Mitral valve aneurysms (MVAs) are rarely encountered in echocardiography laboratories. Although they are commonly associated with endocarditis of the aortic valve, various mechanisms have been suggested for the etiopathogenesis of MVAs associated with non-infectious conditions. 5,887 patients who underwent transesophageal echocardiography (TEE) between 2007 and 2012 were evaluated retrospectively for MVA. Mitral valve aneurysm is defined as a localized saccular bulging of the mitral leaflet towards the left atrium with systolic expansion and diastolic collapse. The color flow Doppler image of a perforation was described as a high-velocity turbulent jet traversing a valve leaflet in systole. We found that 12 of 5,887 patients (0.204 %) had MVA in TEE examinations. The mean age of patients with MVA was 53 years (range 21-80 years), including four females and eight males. Nine patients presented with symptoms of endocarditis. On TEE, aneurysms were located in the anterior mitral leaflet in 11 patients, and in the posterior mitral leaflet in one patient. Eight patients had severe, three had moderate, and one had trace mitral regurgitation. Of the nine patients with perforated leaflets, eight patients had severe and one patient had moderate mitral regurgitation. Aortic regurgitation was present in nine patients, being severe in three, moderate in two, mild in two, and trace in two patients. Two patients without severe mitral regurgitation were followed-up conservatively, while nine patients underwent surgery. Two patients died from septic shock, one in the postoperative period and the other one prior to surgery. Although MVAs occur during the course of aortic valve endocarditis and, in particular, due to aortic regurgitation jet, it should be borne in mind that they may develop as an isolated valvular pathology and may be misdiagnosed as chordal rupture, other cardiac masses, or vegetation. Thus, MVAs may not be so infrequent as they are thought; they may justify to be considered in the differential diagnosis of masses seen on the mitral valve on echocardiographic examination.

Rare Mycotic Aneurysm of the Mitral Valve without Aortic Valve Involvement

“…7 Most pathogens associated with MA are bacterial. 4 Three-dimensional TEE was useful for diagnosing the MV aneurysm in this case, as it allowed for further MV visualization, the ballooning of the aneurysm during systole, and its collapse during diastole. 10 Among the imaging options available to diagnose valvular MA, TEE is the ideal modality, as it has higher sensitivity for assessing MV leaflet morphology than TTE.…”

“…8,9 Gram-positive bacteria are the predominant bacterial class implicated in MA, with the primary organisms being staphylococcal species, or streptococcal species as in our case. 4 In contrast to noninfectious aneurysms, management of MA is made difficult by the fact that the size, location, and morphologic features of MA are poorly predictive of which ones will rupture. 4 Three-dimensional TEE was useful for diagnosing the MV aneurysm in this case, as it allowed for further MV visualization, the ballooning of the aneurysm during systole, and its collapse during diastole.…”

“…MA are an irreversible weakening and dilatation of the arterial wall as a result of an inflammatory process induced by septic emboli, bacteremia, direct bacterial inoculation, or contiguous infection. [4][5][6] We present a case of a MA of the anterior MV leading to a flail mitral leaflet and acute severe MR in which there was no associated aortic valve endocarditis or regurgitation. MV aneurysms can further be complicated by thrombus formation within the aneurysm leading to embolism.…”

A ruptured mitral valve aneurysm as complication of a bicuspid aortic valve endocarditis

“…affirmed that larger aneurysm size does not necessarily correlate with a higher risk of perforation. [5] The moment of aneurysm perforation might be a crucial point for peripheral embolization. Although TTE may occasionally identify subtle valvular abnormalities, the better resolution provided by TEE yields a more definitive identification of these rare lesions.…”

Large mitral valve aneurysm with infective endocarditis

“…Their prevalence is 0.2–0.29% of the TEE studies,2 5 and they are most frequently seen in association with IE of the aortic valve 1–3 5. Gonzalez-Lavin et al reported that 2 of 58 patients (3.4%) who underwent aortic valve surgery for IE presented with a mitral leaflet aneurysm 6.…”