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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.


Related in: MedlinePlus

Histopathology of the mitral valve aneurysm. a and b. Low-power (X 5 original magnification) microphotograph of the mitral valve aneurysm showing prominent myxomatous changes observed after a haematoxylin and eosin, and b Masson Trichrome staining. c. Low-power (X 10 original magnification) microphotograph showing no infiltration by inflammatory cells or active endocarditis in the posterior mitral leaflet
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Fig5: Histopathology of the mitral valve aneurysm. a and b. Low-power (X 5 original magnification) microphotograph of the mitral valve aneurysm showing prominent myxomatous changes observed after a haematoxylin and eosin, and b Masson Trichrome staining. c. Low-power (X 10 original magnification) microphotograph showing no infiltration by inflammatory cells or active endocarditis in the posterior mitral leaflet

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
Histopathology of the mitral valve aneurysm. a and b. Low-power (X 5 original magnification) microphotograph of the mitral valve aneurysm showing prominent myxomatous changes observed after a haematoxylin and eosin, and b Masson Trichrome staining. c. Low-power (X 10 original magnification) microphotograph showing no infiltration by inflammatory cells or active endocarditis in the posterior mitral leaflet
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

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

Fig5: Histopathology of the mitral valve aneurysm. a and b. Low-power (X 5 original magnification) microphotograph of the mitral valve aneurysm showing prominent myxomatous changes observed after a haematoxylin and eosin, and b Masson Trichrome staining. c. Low-power (X 10 original magnification) microphotograph showing no infiltration by inflammatory cells or active endocarditis in the posterior mitral leaflet
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.


Related in: MedlinePlus