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

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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.


Intraoperative aspect and histopathology of the posterior mitral valve leaflet. a. Intraoperative aspect of the MVA on the posterior mitral leaflet (arrow). b. The excised MVA was a part of the mid-posterior leaflet (P2). c. The excised MVA measured 6 mm in diameter
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Fig4: Intraoperative aspect and histopathology of the posterior mitral valve leaflet. a. Intraoperative aspect of the MVA on the posterior mitral leaflet (arrow). b. The excised MVA was a part of the mid-posterior leaflet (P2). c. The excised MVA measured 6 mm in diameter

Mentions: The patient underwent open-heart, triangular resection of the P2 segment of the mitral valve and annuloplasty with a 28-mm Séguin ring. Intraoperative inspection confirmed the presence of an aneurysm on the posterior mitral leaflet (Fig. 4a-c). High- and low-power histopathologic microphotographs showed myxomatous degeneration, without active mitral valve endocarditis or inflammatory cellular infiltration of the posterior leaflet (Fig. 5a-c). The postoperative course was uneventful and the chest discomfort resolved during the postoperative rehabilitation program. The patient was discharged from postoperative rehabilitation, 2 weeks after the operation, and has remained free from significant MR over a 2-year follow-up.Fig. 4


Severe mitral regurgitation due to mitral leaflet aneurysm diagnosed by three-dimensional transesophageal echocardiography: a case report
Intraoperative aspect and histopathology of the posterior mitral valve leaflet. a. Intraoperative aspect of the MVA on the posterior mitral leaflet (arrow). b. The excised MVA was a part of the mid-posterior leaflet (P2). c. The excised MVA measured 6 mm in diameter
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

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

Fig4: Intraoperative aspect and histopathology of the posterior mitral valve leaflet. a. Intraoperative aspect of the MVA on the posterior mitral leaflet (arrow). b. The excised MVA was a part of the mid-posterior leaflet (P2). c. The excised MVA measured 6 mm in diameter
Mentions: The patient underwent open-heart, triangular resection of the P2 segment of the mitral valve and annuloplasty with a 28-mm Séguin ring. Intraoperative inspection confirmed the presence of an aneurysm on the posterior mitral leaflet (Fig. 4a-c). High- and low-power histopathologic microphotographs showed myxomatous degeneration, without active mitral valve endocarditis or inflammatory cellular infiltration of the posterior leaflet (Fig. 5a-c). The postoperative course was uneventful and the chest discomfort resolved during the postoperative rehabilitation program. The patient was discharged from postoperative rehabilitation, 2 weeks after the operation, and has remained free from significant MR over a 2-year follow-up.Fig. 4

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.