Mitral valve aneurysm: Clinical features, echocardiographic-pathologic correlations

Abstract

Aneurysm of the mitral valve occurs most commonly in association with infective endocarditis of the aortic valve. The probable mechanism of its formation is destruction of the aortic valve which results in a regurgitant jet that strikes the anterior leaflet of the mitral valve, creating a secondary site of infection leading to the development of an aneurysm. Perforation of these aneurysms may occur, resulting in mitral regurgitation and pulmonary edema from a ventricle already volume overloaded from aortic regurgitation. This report describes the clinical and echocardiographic-pathologic findings in five patients with pathologically proven aneurysm of the mitral valve. There are no clinical features that appear specific for this abnormality. The two-dimensional echocardiographic feature that is helpful in the diagnosis is a bulge of the mitral valve leaflet toward the left atrium that persists throughout the cardiac cycle. Preoperative diagnosis is important because a mitral valve aneurysm may produce serious complications and is frequently overlooked during surgery. Repair of the aneurysm may be feasible; otherwise, valve replacement becomes necessary. Careful two-dimensional echocardiographic examination should be done in patients with left-sided infective endocarditis to detect an aneurysm of the mitral valve.

An aneurysm of posterior mitral valve mimicking a huge vegetation

“…It usually occurs as an early or late complication of aortic valve endocarditis because infection spreads to the mitral valve. According to previous reports, the location of aneurysmal mitral leaflet was always on the anterior mitral leaflet due to the direction of the aortic regurgitant jet [1]. The major complication of the mitral valve aneurysm is rupture of aneurysmal cavity into left atrium.…”

Two-Dimensional and Color Doppler Echocardiographie Detection of a Ruptured Aneurysm of the Aortic Valve in Infective Endocarditis

“…The two-dimensional échocardiographie feature of the mitral valve aneurysm is reported to be a bulge of the mitral valve leaflet toward the left atrium that persists throughout the cardiac cycle [3]. However, a mitral valve 123…”

“…A double-chambered aneurysm of the right coronary cusp was documented by two-dimensional echocardiography and a perforation of the apex of its posterior chamber was diagnosed by color Doppler echocardiography, which was confirmed at the operation.With the development of two-dimensional echocardi ography, aneurysm of the mitral valve, although uncom mon, has become a well-recognized complication of leftsided endocarditis [1][2][3]. Aortic valve endocarditis ac companied by aortic regurgitation is the most common cause.…”

Perforated Mitral Valve Aneurysm in the Anterior Leaflet Associated With Lateral Scallop Prolapse

“…Mitral valve aneurysm in the anterior leaflet is frequently associated with infective endocarditis involving the aortic valve because of the aortic regurgitant jet which strike the anterior leaflet of the mitral valve [1][2][3][4][5]. However, interestingly in this patient, we could not find aortic valve regurgitation and considered that the eccentric regurgitant jet toward the anterior leaflet due to lateral scallop prolapse caused the structural weakening and then the aneurysm in the anterior leaflet during the previous infective endocarditis which had not been clinically diagnosed.…”