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

Abstract

Different etiologies and formation mechanisms can occur in MVA. Echocardiography plays a fundamental role, providing meticulous examination of the mitral valve anatomy and flow. Unlike standard recommendations, clinical management is possible, and diagnosis does not imply immediate surgical correction.

Unusual Lesions of the Mitral Valve: Two Different Conditions with the Same Imaging Findings

“…It is postulated that they may correspond to degenerative myxomatous processes and collagen diseases. Some argue that in cases of noninfectious aortic insufficiency, mechanical trauma to the anterior MV leaflet of the regurgitant jet may be another cause of the development of the aneurysmal lesion 5 . In our second patient, the possible valvular trauma generated during the surgical intervention is proposed as a likely cause of the MV aneurysm.…”

“…After the anterior mitral leaflet is compromised by the mechanical stress, an inflammatory process is perpetuated, which thins and destroys the mitral leaflet fibers, leading to the aneurysmal formation 8 . The previously proposed mechanisms are described in two of the largest MV aneurysm series,5, 6 which included 23 lesions, 21 located at the anterior leaflet (19 with aortic valvular endocarditis and two with primary infection of the anterior mitral leaflet) and the remaining two located at the posterior mitral leaflet.…”

“…MV aneurysms are infrequent, with a reported incidence of about 0.02% to 0.29% 3 . They were initially described in 1729 by Morand 4 and consist of a thin-walled saccular formation protruding into the atrium in systole that collapses during diastole 5 …”

“…Current literature on the etiology of MV aneurysm suggests an infectious process as the leading cause, in particular aortic valve endocarditis followed by MV coinfection 5, 6. In patients with aortic valve endocarditis, MV aneurysms occur secondary to the close relationship between the aortic valve and the anterior mitral leaflet.…”

Ruptured Mitral Valve Aneurysm: A Rare Complication of Mitral Valve Endocarditis

“…Although they can occur in a non-infectious setting, most frequently they are a consequence of infective endocarditis and affect the anterior leaflet of the mitral valve 1). It is thought that infection causes leaflet degeneration through localized inflammation, dissection and consequent expansion of the valvular tissue towards the left atrium 2). Although conservative management with close follow-up may be possible in some aneurysms, mitral valve replacement surgery should be promptly considered in complicated cases 3)…”