Infective Endocarditis of the Aortic Valve with Anterior Mitral Valve Leaflet Aneurysm

Abstract

Mitral valve leaflet aneurysm is a rare and potentially devastating complication of aortic valve endocarditis. We report the case of a 48-year-old man who had endocarditis of the native aortic valve and a concomitant aneurysm of the anterior mitral valve leaflet. Severe mitral regurgitation occurred after the aneurysm perforated. The patient showed no signs of heart failure and completed a 6-week regimen of antibiotic therapy before undergoing successful aortic and mitral valve replacement. In addition to the patient's case, we review the relevant medical literature.

Mitral valve aneurysms: Clinical characteristics, echocardiographic abnormalities, and possible mechanisms of formation

“…Aortic valve endocarditis is the most common condition related to MVA, especially when significant aortic regurgitation is present …”

“…Mitral valve repair or replacement is indicated when the aneurysm is ruptured or when the unruptured aneurysm is either large or accompanied by significant regurgitation. Surgery is generally indicated; however, uncomplicated aneurysms have been safely followed using more conservative strategy …”

“…3 Mitral valve aneurysms seem to be more common on the anterior leaflet than the posterior. 14,15 Differential diagnoses of these lesions include mitral valve abscess, atypical mitral valve prolapse, cystic atrial myxoma, flail leaflet, blood cyst of the papillary muscle, and mitral valve nonendothelialized cyst. 11 Aortic valve endocarditis is the most common condition related to MVA, especially when significant aortic regurgitation is present.…”

“…Surgery is generally indicated; however, uncomplicated aneurysms have been safely followed using more conservative strategy. 14,24 Conservative management before surgery for infective endocarditis with MVA, with or without perforation, can be safe and beneficial, enable infected tissue healing and recovery, and possibly prevent extensive surgical procedures. 24 To our knowledge, this is the largest MVA case series ever published.…”

Mitral Valve Leaflet Aneurysm-Dynamic CT and Echocardiographic Appearances

“…A mitral valve leaflet aneurysm (MVLA) is a rarely encountered pathology with an estimated incidence of 0.03% and is most commonly seen as a complication of infective endocarditis [1][2][3]. Other causes include connective tissue disorders, rheumatic heart disease and aortic regurgitation [4][5][6].…”