This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Cai, T. H. Articles by Sako, E. Y. Search for Related Content PubMed PubMed Citation Articles by Cai, T. H. Articles by Sako, E. Y. Pubmed/NCBI databases Medline Plus Health Information Aneurysms Related Collections Infectious endocarditis Valvular heart disease Echocardiography CV surgery: valvular disease

(Circulation. 1999;100:e53-e56.)
© 1999 American Heart Association, Inc.

Circulation Electronic Pages

Mitral Valve Aneurysm Due to Severe Aortic Valve Regurgitation

Tung H. Cai, MD; Joe M. Moody, Jr, MD; Edward Y. Sako, MD, PhD

From the Divisions of Thoracic Surgery (T.H.C., E.Y.S.) and Cardiology (J.M.M.), Audie L. Murphy VA Hospital, University of Texas Health Science Center at San Antonio.

Correspondence to Edward Y. Sako, MD, PhD, Division of Thoracic Surgery, University of Texas Health Science Center, 7703 Floyd Curl Dr, San Antonio, TX 78284-7841.

	Introduction

 
A 33-year-old man presented to the hospital with shortness of breath and chest pain. He was subsequently diagnosed with Streptococcus mitis endocarditis involving the aortic valve. The initial echocardiogram revealed moderate aortic valve regurgitation and a normal mitral valve without regurgitation. The patient was treated with afterload reduction and antibiotics. Blood cultures were negative within 2 days after initiation of antibiotics. He returned to the hospital 1 month later with worsening symptoms, and a repeat echocardiogram showed worsening aortic valve regurgitation. A mitral valve aneurysm was also visualized, with moderate mitral valve regurgitation. The aneurysm was located on the anterior leaflet near the septal commissure and was due to regurgitant blood flow from the aortic valve. Because of worsening of aortic valve regurgitation and refractory symptoms, the patient was referred for surgery. The aortic valve was replaced with a No. 23 St Jude mechanical prosthesis. The mitral valve aneurysm was resected and the defect in the anterior leaflet primarily repaired. A No. 30 Baxter annuloplasty ring was also placed. Pathological evaluation of the aneurysm revealed chronic inflammation without evidence of active endocarditis. The patient recovered uneventfully and was discharged home with anticoagulation.

View larger version (89K): [in this window] [in a new window]   Figure 1. Initial transesophageal echocardiography showing intact mitral valve. LA indicates left atrium; LV, left ventricle.

View larger version (87K): [in this window] [in a new window]   Figure 2. Transesophageal echocardiography at second presentation revealing aneurysm in anterior leaflet. MVA indicates mitral valve aneurysm; other abbreviations as in Figure 1.

View larger version (45K): [in this window] [in a new window]   Figure 3. Color Doppler of Figure 2 showing regurgitant aortic insufficiency jet hitting mitral valve. Abbreviations as . . . [Full Text of this Article]

This article has been cited by other articles:

				M. E. Halkos, J. D. Symbas, J. M. Felner, and P. N. Symbas Aneurysm of the Mitral Valve: A Rare Complication of Aortic Valve Endocarditis Ann. Thorac. Surg., October 1, 2004; 78(4): e65 - e66. [Abstract] [Full Text] [PDF]

				C. Piper, R. Hetzer, R. Korfer, R. Bergemann, and D. Horstkotte The importance of secondary mitral valve involvement in primary aortic valve endocarditis. The mitral kissing vegetation Eur. Heart J., January 1, 2002; 23(1): 79 - 86. [Abstract] [Full Text] [PDF]

				K.-L. Chan, T. H. Cai, E. Y. Sako, and J. M. Moody Jr Mitral Valve Aneurysm in Endocarditis Response Circulation, September 26, 2000; 102 (13): e102 - e102. [Full Text] [PDF]