Limits...
Severe mitral regurgitation due to mitral leaflet aneurysm diagnosed by three-dimensional transesophageal echocardiography: a case report

View Article: PubMed Central - PubMed

ABSTRACT

Background: A small mitral valve aneurysm (MVA) presenting as severe mitral regurgitation (MR) is uncommon.

Case presentation: A 47-year-old man with a history of hypertension complained of exertional chest discomfort. A transthoracic echocardiogram (TTE) revealed the presence of MR and prolapse of the posterior leaflet. A 6-mm in diameter MVA, not clearly visualized by TTE, was detected on the posterior leaflet on a three-dimensional (3D) transesophageal echocardiography (TEE). The patient underwent uncomplicated triangular resection of P2 and mitral valve annuloplasty, and was discharged from postoperative rehabilitation, 2 weeks after the operation. Histopathology of the excised leaflet showed myxomatous changes without infective vegetation or signs of rheumatic heart disease.

Conclusions: A small, isolated MVA is a cause of severe MR, which might be overlooked and, therefore, managed belatedly. 3D TEE was helpful in imaging its morphologic details.

Electronic supplementary material: The online version of this article (doi:10.1186/s12872-016-0413-1) contains supplementary material, which is available to authorized users.

No MeSH data available.


Related in: MedlinePlus

Left ventriculography. Right anterior oblique, 30° view of grade 3 to 4 mitral regurgitation (Seller’s grading)
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

License 1 - License 2
getmorefigures.php?uid=PMC5120478&req=5

Fig3: Left ventriculography. Right anterior oblique, 30° view of grade 3 to 4 mitral regurgitation (Seller’s grading)

Mentions: A 47-year-old man with a 10-year history of hypertension complained of exertional chest discomfort. On physical examination, he was alert, his height and body weight were 168.5 cm and 78 kg, respectively, body temperature 36.3 °C, systemic blood pressure 152/82 mmHg and heart rate 56 bpm. The percutaneous oxygen saturation on room air was 97%. A III/VI systolic murmur was heard at the apex, radiating to the left axilla, without manifestation of cardiac decompensation. He had no sign of Marfan’s syndrome. The laboratory tests revealed a 4.0 × 103/mm3 white blood cell count with 66% granulocytes and 27% lymphocytes, a 20.4 × 104/mm3 platelet count, 15.7 g/dl haemoglobin concentration, and 0.03 mg/dl C-reactive protein serum concentration. A chest roentgenogram showed a 48% cardiothoracic ratio, and the 12-lead electrocardiogram showed a high QRS voltage in the lateral precordial leads. A transthoracic echocardiogram (TTE) revealed MR with prolapse of the posterior leaflet (Fig. 1a-c) without vegetation or aortic regurgitation. The echocardiographic left atrial and left ventricular (LV) dimensions and LV ejection fraction are shown in Table 1A. A two-dimensional transoesophageal echocardiogram (TEE) showed mitral valve prolapse (Fig. 2a and c) and MR with a significant proximal isovelocity surface area (PISA) (Fig. 2b and d). On three-dimensional (3D) TEE, a 6-mm in diameter aneurysm was present on the posterior mitral valve leaflet, which was not clearly visible on TTE (Fig. 2e and Additional file: Video S1). 3D full-volume colour TEE was also useful for illustrating the spatial relationship between the MVA and the MR jet (Fig. 2f and Additional file: Video S2). A LV angiogram (Fig. 3 and Additional file: Video S3) showed grade 3–4 MR and coronary angiograms showed no significant stenosis. The pressures measured during right heart catheterization are shown in Table 1B. Cardiac index was within normal limits (Table 1B).Fig. 1


Severe mitral regurgitation due to mitral leaflet aneurysm diagnosed by three-dimensional transesophageal echocardiography: a case report
Left ventriculography. Right anterior oblique, 30° view of grade 3 to 4 mitral regurgitation (Seller’s grading)
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC5120478&req=5

Fig3: Left ventriculography. Right anterior oblique, 30° view of grade 3 to 4 mitral regurgitation (Seller’s grading)
Mentions: A 47-year-old man with a 10-year history of hypertension complained of exertional chest discomfort. On physical examination, he was alert, his height and body weight were 168.5 cm and 78 kg, respectively, body temperature 36.3 °C, systemic blood pressure 152/82 mmHg and heart rate 56 bpm. The percutaneous oxygen saturation on room air was 97%. A III/VI systolic murmur was heard at the apex, radiating to the left axilla, without manifestation of cardiac decompensation. He had no sign of Marfan’s syndrome. The laboratory tests revealed a 4.0 × 103/mm3 white blood cell count with 66% granulocytes and 27% lymphocytes, a 20.4 × 104/mm3 platelet count, 15.7 g/dl haemoglobin concentration, and 0.03 mg/dl C-reactive protein serum concentration. A chest roentgenogram showed a 48% cardiothoracic ratio, and the 12-lead electrocardiogram showed a high QRS voltage in the lateral precordial leads. A transthoracic echocardiogram (TTE) revealed MR with prolapse of the posterior leaflet (Fig. 1a-c) without vegetation or aortic regurgitation. The echocardiographic left atrial and left ventricular (LV) dimensions and LV ejection fraction are shown in Table 1A. A two-dimensional transoesophageal echocardiogram (TEE) showed mitral valve prolapse (Fig. 2a and c) and MR with a significant proximal isovelocity surface area (PISA) (Fig. 2b and d). On three-dimensional (3D) TEE, a 6-mm in diameter aneurysm was present on the posterior mitral valve leaflet, which was not clearly visible on TTE (Fig. 2e and Additional file: Video S1). 3D full-volume colour TEE was also useful for illustrating the spatial relationship between the MVA and the MR jet (Fig. 2f and Additional file: Video S2). A LV angiogram (Fig. 3 and Additional file: Video S3) showed grade 3–4 MR and coronary angiograms showed no significant stenosis. The pressures measured during right heart catheterization are shown in Table 1B. Cardiac index was within normal limits (Table 1B).Fig. 1

View Article: PubMed Central - PubMed

ABSTRACT

Background: A small mitral valve aneurysm (MVA) presenting as severe mitral regurgitation (MR) is uncommon.

Case presentation: A 47-year-old man with a history of hypertension complained of exertional chest discomfort. A transthoracic echocardiogram (TTE) revealed the presence of MR and prolapse of the posterior leaflet. A 6-mm in diameter MVA, not clearly visualized by TTE, was detected on the posterior leaflet on a three-dimensional (3D) transesophageal echocardiography (TEE). The patient underwent uncomplicated triangular resection of P2 and mitral valve annuloplasty, and was discharged from postoperative rehabilitation, 2 weeks after the operation. Histopathology of the excised leaflet showed myxomatous changes without infective vegetation or signs of rheumatic heart disease.

Conclusions: A small, isolated MVA is a cause of severe MR, which might be overlooked and, therefore, managed belatedly. 3D TEE was helpful in imaging its morphologic details.

Electronic supplementary material: The online version of this article (doi:10.1186/s12872-016-0413-1) contains supplementary material, which is available to authorized users.

No MeSH data available.


Related in: MedlinePlus