A 34-year-old black woman presented with a history of progressively worsening exertional dyspnea. Clinical examination revealed left heart failure and mitral regurgitation. Echocardiography showed a large, partially thrombosed submitral aneurysm arising immediately below the posterior mitral leaflet (Figure⇓, left and center). Color Doppler flow imaging demonstrated systolic flow into the aneurysm and mitral regurgitation (right). The mechanism for the latter was interference of the aneurysm with posterior mitral leaflet function.
Submitral aneurysms are a well-described entity among black Africans. They are thought to be false aneurysms caused by a congenital defect in the posterior portion of the mitral annulus and may produce symptoms through diastolic overload (by virtue of their volume or by causing mitral regurgitation), thromboembolism, arrhythmias, or compression of the left circumflex artery.
This patient had a successful surgical repair of the aneurysm and mitral valve repair.
The editor of Images in Cardiovascular Medicine is Hugh A. McAllister, Jr, MD, Chief, Department of Pathology, St Luke’s Episcopal Hospital and Texas Heart Institute, and Clinical Professor of Pathology, University of Texas Medical School and Baylor College of Medicine.
Circulation encourages readers to submit cardiovascular images to Dr Hugh A. McAllister, Jr, St Luke’s Episcopal Hospital and Texas Heart Institute, 6720 Bertner Ave, MC1–267, Houston, TX 77030.
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