Mitral Valve Aneurysm Research Articles

A mitral valve aneurysm: A rare complication of aortic valve endocarditis

A mitral valve aneurysm: A rare complication of aortic valve endocarditis

Aneurysm of the Anterior Mitral Valve Complicating Infectious Mitro-Aortic Endocarditis in a Biscuspid Aortic Valve: About a Case

Mitral valve aneurysm is a rare condition usually associated with aortic valve endocarditis. The mechanism, poorly understood, generally includes a regurgitant infectious flow originating from the aortic valve, direct contact with vegetation and direct propagation, through adjacent structures, such as the mitro-aortic intervalvular fibrous body. This report details the case of a 56-year-old patient followed for severe bicuspid aortic insufficiency of the aortic valve for 4 months and admitted to heart failure due to infectious endocarditis with a fatal outcome. Physical examination revealed aortic and mitral insufficiency syndrome and congestive heart failure. Transthoracic echocardiography revealed type 1 L-R bicuspid heart disease and leaking polyvalvulopathy with severe eccentric aortic and severe mitral regurgitation. The aortic and mitral valves were the seat of the vegetations. The mitral valve was the seat on its atrial side of a contained aneurysmal sac with thrombosed hyperechogenicity. Blood cultures were positive for streptococci and probabilistic dual antibiotic therapy was started. The patient was unable to benefit from surgical treatment. However, the patient died following complications such as ischemic stroke and septic shock. A necropsy was not done.

Rare complications of infective endocarditis in marfan-like morphotype: diagnosis of multiple mitral valve aneurysms and aortic root abscess using three-dimensional transesophageal echocardiography

Mitral valve aneurysm (MVA) is characterized by a saccular outpouching of the mitral leaflet, and it represents a rare condition typically associated with aortic valve endocarditis. Three-Dimensional Transesophageal Echocardiography (3D-TEE) serves as an effective tool for detecting the presence of MVA and its potential complications. In this report, we present a case involving a young man with striking images of bicuspid aortic valve endocarditis complicated by an aortic root abscess and multiple perforated mitral valve aneurysms, diagnosed using 3D TEE. This case suggests the uncommon coexistence of Marfan like morphotype, bicuspid aortic valve, and infective endocarditis as a triple mechanism in the occurrence of MVA. It underscores the significance of early and accurate imaging diagnosis for facilitating prompt surgical intervention.

Echocardiography Diagnosis of Mitral Valve Aneurysm Complicated with Infective Endocarditis.

Mitral valve aneurysm (MVA) is a relatively rare but life-threatening condition that may occur as a complication of an infective endocarditis (IE) involved aortic valve. Rupture of the valve aneurysm is one of the most serious complications, which could result in severe mitral regurgitation and cause rapid hemodynamic deterioration, especially in heart failure patients. Timely diagnosis using echocardiography and appropriate treatments, such as invasive surgical repair or replacement of the valve, can effectively prevent catastrophic complications. Here, we present a 57-year-old male patient with MVA after IE and emphasize the key role of echocardiography in the early diagnosis and management of these kinds of conditions.

An incidental finding of a challenging mitral mass: cardiac surgery or not?

We present a case of an occasional finding of cardiac mass linked to the mitral valve, diagnosed as a posterior leaflet mitral valve aneurysm and not determining valve dysfunction or related to endocarditis. A wait-and-see strategy has been set up.

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

The accurate etiology of mitral valve aneurysm (MVA) formation is not completely understood, and the most effective management approach for this condition remains controversial. We retrospectively analyzed 20 MVA patients who underwent either surgical interventions or conservative follow-ups at the Zhongnan Hospital of Wuhan University between 2017 and 2021. We examined their clinical, echocardiographic, and surgical records and tracked their long-term outcomes. Of the 20 patients, 12 were diagnosed with MVA using transthoracic echocardiography, seven required additional transesophageal echocardiography for a more definitive diagnosis, and one child was diagnosed during surgery. In all these patients, the MVAs were detected in the anterior mitral leaflet. We found that 15 patients (75%) were associated with infective endocarditis (IE), whereas the remaining patients were associated with bicuspid aortic valve and moderate aortic regurgitation (AR) and mild aortic stenosis (5%), congenital heart disease (5%), elderly calcified valvular disease (5%), mitral valve prolapse (5%), and unknown reasons (5%). Of the 17 patients who underwent hospital surgical interventions, two died due to severe cardiac events. The remaining 15 patients had successful surgeries and were followed up for an average of 13.0 ± 1.8 months. We observed an improvement in their New York Heart Association functional class and mitral regurgitation and AR degrees (P-value < 0.001). During follow-up, only one infant had an increased left ventricular end-diastolic diameter and left ventricular end-systolic diameter, whereas the remaining 14 patients had decreased values (P < 0.001). In addition, none of the three conservatively managed patients experienced disease progression during the 7-24 months of follow-up. We recommend using echocardiography as a highly sensitive method for MVA diagnosis. Although most cases are associated with IE or AR, certain cases still require further study to determine their causes. A prompt diagnosis of MVA in patients using echocardiography can aid in its timely management.

Rare Case of Mitral Valve and Tricuspid Valve Aneurysm Presented with Progressive Dyspnea

Rare Case of Mitral Valve and Tricuspid Valve Aneurysm Presented with Progressive Dyspnea

A Case of Perforated Infected Aneurysm of Mitral Valve Initially Misdiagnosed as a Tumoral Lesion.

A Case of Perforated Infected Aneurysm of Mitral Valve Initially Misdiagnosed as a Tumoral Lesion.

407 AN INCIDENTAL FINDING OF A CHALLENGING MITRAL MASS

Abstract A 53-year-old woman, with no previous cardiologic history, presented to our emergency department reporting a pleomorphic symptomatology that had been affecting her in the last few months. She complained weakness, dyspnea for severe exertion and intermittent atypical chest pain worsening with the supine position. The patient had a history of migraine with aura. On admission she was asymptomatic and apyretic. Her blood pressure was 120/80 mmHg. Clinical examination revealed rhythmic heart sounds without murmurs, normal lung sounds, no jugular venous distention and no peripheral edema, no signs nor symptoms of infection. Her laboratory tests showed normal cardiac high-sensitivity troponin I (4.1 ng/L), BNP levels (4 ng/L) and C-reactive protein 0.3 mg/dL. The electrocardiogram showed a sinus rhythm with a rate of 86 beats/min, AV conduction and ventricular repolarization were within normal limits. Transthoracic echocardiogram revealed a normal sized (end-diastolic diameter 40 mm), slightly hypertrophic left ventricle (interventricular septum thickness 12 mm) with normal ejection fraction (55%), inferior-lateral wall curling and grade I diastolic dysfunction. Left atrium size was normal. A 15×14 mm globe-shaped echogenic structure was seen protruding in the left atrium throughout the whole cardiac cycle, which apparently originated from the P2 scallop (Figure 1A). There were no signs of mitral regurgitation or stenosis. Aortic valve was normal. Inferior vena cava was not dilated and collapsing. During the hospitalization she was always apyretic and asymptomatic, laboratory tests and blood culture negative. Transesophageal echocardiography showed a saccular cavitary structure, 14 mm in diameter bulging from the posterior mitral leaflet toward the left atrium throughout systole and diastole (Figure 1B). Differential diagnosis included cardiac tumor (e.g., fibroelastoma), and mitral valve aneurysm and/or excessive P2 prolapse. The absence of history of endocarditis, mitral regurgitation and the involvement of the posterior leaflet favored the first hypothesis, whilst morphology the latter. Libman-Sacks endocarditis was excluded thanks to lesions morphology and the absence of history of cancer or autoimmune disease. We performed a cardiac MRI investigation which confirmed the presence of bi-leaflet mitral prolapse with a thickened, dysmorphic and abnormal posterior mitral leaflet without any evidence of cardiac tumors (Figure 2). No regurgitation was found. Adiposus intramyocardial tissue was also reported in the inferior-lateral wall, supporting the diagnosis of atypical mitral valve prolapse with aneurysmatic posterior leaflet. Finally, a brain MRI excluded prior cerebral embolism. We therefore decided to follow-up the patient, who at 6 months remained asymptomatic without any medical therapy. Figure 1.A: transthoracic echocardiography (apical four-chamber view) showing the mitral mass. B: transesophageal echocardiography (three-chamber view with X-plane section) showing the mitral mass as an aneurysmatic posterior mitral leaflet at P2 level. C: 3D transesophageal echocardiography showing the aneurysmatic posterior mitral leaflet.Figure 2.Cardiac MRI (three-chamber view) showing the mitral posterior leaflet prolapse with aneurysm.

Impressive Mitral Valve Aneurysm Following Thickening of the Anterior Leaflet.

Impressive Mitral Valve Aneurysm Following Thickening of the Anterior Leaflet.

Microvascular Retinal Changes in Patients with Marfan Syndrome

Purpose To determine microvascular changes in patients with genetically proven Marfan syndrome. Methods In a cross-sectional study, 32 eyes of 16 patients with genetically proven Marfan syndrome were evaluated using swept-source optical coherence tomography angiography (SS-OCTA). Patients were analyzed regarding lens status and systemic vascular disease. The foveal avascular zone (FAZ) and vessel density (VD) of the superficial and deep vascular plexus and central retinal thickness (CRT) were evaluated on SS-OCTA. Results 44/56% patients presented without/with subluxation of the lens. 69% of patients had presence of mitral valve insufficiency, aortic dilatation or aneurysm of the aortic root. In patients with Marfan syndrome the mean area of the FAZ was 0.2 ± 0.1 mm and the average VD of the superficial/deep vascular plexus was 36 ± 5%/22 ± 7%. In patients with subluxation of the lens FAZ area and perimeter were larger when compared to patients without subluxation of the lens (0.18 ± 0.08/0.28 ± 0.10 mm and 1.7 ± 0.4/2.3 ± 0.8; p = 0.02). VD of the superficial vascular plexus was reduced in patients with subluxation of the lens (on average 39 ± 3/33 ± 8; p = 0.01) together with an increased CRT in the inner segments of the ETDRS grid when compared to patients without subluxation of the lens. In patients with systemic vascular disease a larger FAZ area (0.19 ± 0.06/0.25 ± 0.1 mm; p = 0.04) and reduced VD of the superficial vascular plexus in the central ETDRS grid (28 ± 7/21 ± 6; p = 0.02) was observed in comparison to patients without systemic vascular changes. Conclusions In patients with Marfan syndrome SS-OCTA imaging revealed microvascular differences in patients with lens subluxation and/or systemic vascular disease.

Osteogenesis Imperfecta With Cerebral Atherosclerosis: A Family Report

Background: Osteogenesis imperfecta (OI) is a rare hereditary connective tissue disease. It is mainly associated with pathogenic variants in COL1A1 or COL1A2. Patients with OI usually have repeated history of bone fractures. Besides, osteogenesis imperfecta is associated with some cardiovascular complications, such as aortic and mitral valve dysfunction, aneurysm and aortic dissection. But the relationship between these diseases has not been well studied. Case Presentation: A 55-year-old man was admitted to our hospital mainly due to “dizziness for 2 hours”. He had a 4-month history of hypertension and a history of smoking for more than 20 years. He had no history of drinking alcohol. He had hunchback and O-type legs. Besides, the patient and some of his relatives had a history of repeated brittle fractures,which was considered as “osteogenesis imperfecta”. The clinical manifestation of OI in this family varies to a certain extent, from simple tooth disintegration to severe fracture deformity. The most serious patient of his family was unable to walk. CT and MRI revealed multiple systemic arteriosclerosis, including vertebral artery, posterior inferior cerebellar artery, cervical artery, and bilateral cerebellar multiple lacunar cerebral infarction. The blood sample of the patient was tested by whole exome sequencing, and the saliva samples of the patient’s family members were tested by Sanger sequencing. A mutation c.3159 + 2T > A was detected in COL1A2 gene associated with OI, also found in the other affected family members, which had not been reported before. It was a segregating mutation in the family. The clinical severity of the family members was heterogeneous.Discussion: This case is worth learning from the following aspects: 1. A pathogenic heterozygous mutation, c.3159 + 2T > A was detected in COL1A2 gene in the patient with OI, which is not reported in previous cases of OI. 2. The clinical manifestation of OI in this family varies to a certain extent, from simple tooth disintegration to severe fracture deformity. The most serious patient of his family was unable to walk. It presented the clinical heterogeneity of OI. Further basic researh on the mutation site of related gene of OI are needed. 3. We found the possibility of developing cerebral atherosclerosis in patients with OI. Therefore, patients with OI should give up smooking, exercise properly and keep on a low fat diet. They should pay attention to control blood pressure and blood lipid so as to reduce the risk of atherosclerosis. Conclusion: A c.3159 + 2T>A mutation in COL1A2 gene detected by whole exome sequencing was the causing reason of OI, the discovery enriched the gene mutation spectrum of OI. We also found that OI may have relationship with premature atherosclerosis, and the abnormal bones of the cervical spine may lead to vertebrobasilar ischemia.

Fate of moderate aortic regurgitation after cardiac surgery

ObjectiveTo determine the prevalence of concomitant aortic regurgitation (AR) in cardiac surgery and the outcomes of treatment options. MethodsBetween April 2004 and June 2018, 3289 patients underwent coronary artery bypass, mitral valve, or aortic aneurysm surgery without aortic stenosis. AR was graded none/trivial (score = 0), mild (score = 1+), or moderate (score = 2+). Patients with untreated 2+ AR were compared with those with 0 or 1+ AR, and to those with 2+ AR who had aortic valve surgery. Thirty-day and late survival, echocardiography, and clinical outcomes were compared using propensity score matching. ResultsOne hundred thirty-eight patients (4.2%) had 2+ AR; and 45 (33%) received aortic valve repair (n = 9) or replacement (n = 36) in the treated group and were compared with 2765 untreated patients with 0 AR and 386 patients with 1+ AR. Valve surgery was more common with anatomic leaflet abnormalities: bicuspid aortic valve (9% vs 0%; P < .01), rheumatic valve disease (16% vs 3%; P < .01), and calcification (47% vs 27%; P = .021). In unadjusted analysis, lower preoperative AR grade was associated with increased 10-year survival (P < .001). At year 10, progression to more-than-moderate AR among moderate AR patients was 2.6% and late intervention rate was 3.1%. In the untreated 2+ AR group, on last follow-up echocardiogram, 58% had improvement in AR, 41% remained 2+, and only 1% progressed to severe AR. ConclusionsAortic valve surgery in select patients with concomitant moderate AR can be added with minimal added risk, but untreated AR does not influence long-term survival after cardiac surgery and rarely required late intervention.

Volcano-like ruptured posterior mitral valve aneurysm due to infective endocarditis caused by Streptococcus agalactiae.

Volcano-like ruptured posterior mitral valve aneurysm due to infective endocarditis caused by Streptococcus agalactiae.

Mitral Valve Aneurysm in Mitral Valve Endocarditis: A Case Report

Mitral valve aneurysm (MVA) is an ominous complication of infective endocarditis (IE), with worse outcomes seen among patients with preexisting valvular disease or intravenous drug use. Valve aneurysms can perforate or lead to rupture of the chordae tendineae, with the consequent development of severe mitral regurgitation and acute pulmonary edema. We present a case of a 54-year-old woman with hypertension, obesity, diabetes mellitus, hyperlipidemia, chronic obstructive pulmonary disease, peptic ulcer disease, obstructive sleep apnea, gastroesophageal reflux disease, intravenous drug abuse and bipolar disorder who developed MVA one month after being discharged for IE. Decline in the clinical status of patients with IE is a troubling sign that may indicate an IE complication such as MVA. Physicians should diligently monitor patients with IE for changes in signs and symptoms, as early recognition and surgical intervention are key to prevent further morbidity and mortality.

P1693 Mitral valve aneurysm complicating infective endocarditis

Abstract Funding Acknowledgements Nothing to disclose Background Mitral valve aneurysm is an uncommon sequelae of infective endocarditis (IE), early diagnosis and timely intervention is of paramount importance to prevent aneurysm rupture and hemodynamic deterioration. Clinical presentation A 25-years old gentleman with no known past medical history, presented with a history of unexplained fever for the past month partially responding to antipyretics along with exertional dyspnea. On examination he had a blood pressure of 120/80 mmHg, a heart rate of 110 bpm, a temperature of 39oC, a harsh pansystolic murmur over the apex and early diastolic murmur over the second aortic area. Laboratory results revealed anaemia, leukocytosis elevated ESR and CRP and blood cultures were positive for streptococcus viridians. Electrocardiography showed sinus tachycardia. Methods and results Trans-Thoracic Echocardiography (TTE) revealed the presence of an echolucent cavity measured 1.6x1.6 cm overlying a perforation of the anterior mitral valve leaflet (AML) a long with two small vegetations attached to the AML at the perforation edge, largest measures 0.8cm. There was a severe mitral valve regurgitation. The aortic valve is thickened trileaflet with lack of diastolic cooptation and evidence of severe regurgitation. The left ventricle dimensions were dilated and function was reduced, estimated LVEF = 50%. 3DTrans-esophageal Echocardiography(TEE) was done for better visualization of the mitral valve. The cavity involved A2 scallop, it was perforated and communicating with the LA with an additional regurgitation jet. The aortic valve showed no detectable masses or abscesses. Accordingly, patient was diagnosed with infective enfocarditis complicated with AML perforation and aneurysm formation, anti-biotics were commenced and patient was referred for double valve replacement. Discussion Mitral valve aneurysm most commonly occurs secondary to infective endocarditis of the aortic valve, while our patient does not demonstrate evidence of vegetations at the aortic valve but he had an unhealthy valve with severe regurgitation jet that hits AML and might by a cause of hit lesion at the AML and eventually complicated by aneurysm formation. Discussion Echocardiography is a crucial imaging modality in patient with long standing fever and underlying valvular heart disease to rule out infective endocarditis. 3D-TEE is of added value along with TTE in better definition of vegetations, detection of infective endocarditis complication and it has a crucial role in proper diagnosis and surgical planning for better clinical outcomes. Abstract P1693 Figure. Mitral valve aneurysm

P228 Mitral valve aneurysm in the context of post-infective endocarditis in hypertrophic cardiomyopathy: an issue of inflammation or pressure gradients?

Abstract Mitral valve aneurysms (MVA) are uncommon and usually develop acutely in the setting of infective endocarditis (IE). We present a case report of a patient with a ruptured aneurysm of the mitral valve (MV) leaflet and obstructive hypertrophic cardiomyopathy (HCM), previously treated for IE. Echocardiography is essential for diagnosis, highlighting the importance of imaging for early identification and timely intervention. CASE REPORT 68-year-old male patient with type 2 diabetes mellitus and dyslipidemia was admitted to hospital with a 3-week history of malaise, fever and recent left-sided abdominal pain. No past relevant history. Physical examination revealed a grade II/VI systolic heart murmur at the cardiac apex, fever, abdominal tenderness in the left upper quadrant and purpuric lesions in the inferior limbs. Neutrophilia, CPR 211mg/L. Positive blood cultures for Staphylococcus aureus methicillin-sensitive. Spleen embolization, with no abcess on abdominal CT. Transthoracic (TTE) and transesophageal echocardiography (TEE) disclosed a highly mobile polypoid mass in the atrial side of the anterior MV leaflet, septal left ventricular hypertrophy and systolic anterior motion (SAM) of the MV. Mild mitral regurgitation (MR). No evidence of abcess, aneurysm or valve perforation. The diagnosis of IE was established and the patient completed 42 days of Flucloxaciline. Favorable clinical evolution, residual lesions on the MV. TTE and TEE were repeated on follow-up. Besides HCM and SAM of the MV, an aneurysm of the anterior leaflet of the MV was identified and two regurgitant jets: one due to incomplete coaptation of the leaflets; other through the perforated aneurysm. Mild global MR. A strategy of close follow-up was adopted. Beta blocker dose was increased. Maintenance of the characteristics of the aneurysm. DISCUSSION MVA are rare, with perforation and significant MR development as the most serious complications. They mostly develop in the acute setting of IE of the aortic valve (AV), due to the "jet lesion" from the regurgitant jet or direct extension of the infection. In this case, MVA developed as a late complication of IE of the MV. Previous infection and inflammation lead to increased susceptibility of the valve leaflet, with possible persistent chronic inflammation. In the setting of obstructive HCM, the lesioned endothelium is exposed to significant intraventricular pressure gradients, which have probably raised its propensity to bulge towards the atrium, resulting in aneurysm formation and perforation. Optimal approach to MVA has not been defined. If the setting of perforation with severe MR, surgery must be performed in order to avoid a fatal outcome. In small aneurysms with mild MR, a conservative approach seems reasonable. The purpose of this case is to highlight potential complications of IE, which should be actively investigated, with echocardiography playing a central role in the diagnosis and follow-up.

Echocardiographic Evaluation of Anterior Mitral Valve Aneurysm Without Infective Endocarditis

Mitral valve aneurysm (MVA) is un-common and occurs most commonly as a complication of infective endocarditis. Early diagnosis and surgical treatment are of great importance. In this study, we reported a 30-year-old man with anterior MVA in the A2 scallop without concurrent infective endocarditis, which was recognized by preoperative real-time three-dimensional transesophageal echocardiography (RT-3D-TEE) and confirmed at operation with mitral valve replacement. This study presented a rare condition, and valuated the potential application of RT-3D-TEE in MVA diagnosis.

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

Mitral valve aneurysms (MVA) are most frequently associated with endocarditis. Echocardiography is the method of choice for diagnosis, and color flow imaging is an important, easy method to detect MVA ruptures. We aimed to study the clinical and echocardiographic findings and their relation to the mechanism of aneurysm formation. We reviewed clinical and echocardiographic records of 18 patients during a 17-year period, corresponding to 0.02% of the total studies performed at our institution. All patients underwent transthoracic echocardiogram (TTE), and all except two underwent transesophageal echocardiogram (TEE). The aneurysm was located either on the anterior leaflet (16 cases) or on the posterior leaflet (two cases). In seven cases, the probable aneurysm formation mechanism was an aortic regurgitant jet striking the anterior mitral leaflet. Perforation was present in 17 (94.4%) patients, and 10 (55.5%) cases presented more than one aneurysm. No patients underwent surgery exclusively because of the echocardiography finding. 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.

Acquired mitral valve aneurysm due to severe aortic regurgitation

Acquired mitral valve aneurysm due to severe aortic regurgitation