Large mitral valve aneurysm with infective endocarditis

Abstract

SUMMARYA 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. BACKGROUND

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

“…These cases suggest that MVA formation can be attributed to various factors, such as elderly calcified vascular disease, mitral valve prolapse, or other isolated vulvitis. All the MVAs in our study were detected on the anterior mitral leaflet, consistent with most previous reports (2,4,9,10,12,13,22,25,29,30). However, some case studies have reported MVAs on the posterior mitral leaflet (31)(32)(33)(34)(35)(36)(37), possibly induced by inflammation.…”

“…The reported MVA formation mechanisms include direct extension of infection from the aortic valve to the anterior mitral leaflet, impingement of aortic valve regurgitation on the anterior mitral valve leaflet, contact of aortic valve vegetation with the anterior mitral leaflet (kissing lesions), and mitral valve infections (3,5,8,9,12,(21)(22)(23)(24)(25)(26)(27). Aortic valve endocarditis (AVE) is considered the most common cause of MVA (3,4,6,7,9,24,25,28). In our study, 15 out of 20 patients were clinically diagnosed with infective endocarditis, and among them, 10 had AVE and 12 had moderate or severe aortic regurgitation, consistent with the previous findings.…”

“…MVR was the preferred approach in most cases due to the association of MVA with other malformations, making valve repair technically challenging. While MV repair had been shown to have better outcomes than MV replacement, as reported in previous studies (4,39), only a few patients in our study underwent MV repair. Nevertheless, significant improvements in cardiac function and valve hemodynamics were observed during follow-ups for both MV replacement and repair patients.…”

“…Despite the rarity of this condition, several case reports and a few series on MVA have been documented. The exact MVA formation mechanisms remain incompletely understood, with infective endocarditis (IE) and aortic regurgitation (AR) being reported as major contributing factors (3)(4)(5)(6)(7). Other factors, such as connective tissue defects and valve degenerative changes, have also been implicated (1-3, 5-13).…”

An unusual case of giant aneurysm of the noncoronary sinus of Valsalva with rupture into the left ventricular outflow tract along with distortion of the mitral valve

“…This condition is often seen in patients with infective endocarditis of the aortic valve. Some reports have suggested that an infected aortic regurgitant jet is a likely cause of mitral valve aneurysms . Echocardiography shows the leaflet tissue of the mitral valve bulging into the left ventricle, forming a thin‐walled aneurysm‐like structure; (2) Fibrous diverticulum under the aortic valve, which may be caused by a congenital defect or weak development between the muscular ventricular wall and the annulus.…”