Case Reports
Aneurysm of the anterior leaflet of the mitral valve secondary to aortic valve endocarditis*,**

https://doi.org/10.1067/mje.2000.105892Get rights and content

Abstract

Aneurysm of the anterior mitral leaflet is a rare complication of infective aortic valve endocarditis, the natural evolution of which is generally its rupture, with subsequent acute and severe mitral regurgitation. Its presence cannot be recognized with transthoracic echocardiography and even in surgery. We describe a 78-year-old man with aortic valve endocarditis, in whom transesophageal echocardiography was essential for the diagnosis of this complication, its therapeutic management, and the postoperative follow-up after simple valve repair. In addition, the most appropriate surgical approach is discussed. (J Am Soc Echocardiogr 2000;13:1050-2.)

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Case report

A 78-year-old man came to the emergency room with fever lasting 1 week, asthenia, weight loss, progressive dyspnea, oliguria, and edemas in the lower limbs. He had signs of left and right heart failure. A midsystolic and a high-frequency early diastolic murmur could be heard at the second right intercostal space and at the left sternal border; both were graded 2/6 in intensity. The chest x-ray film showed signs of heart failure and left pleural effusion. A transthoracic echocardiogram evidenced

Discussion

The AAML is a rare complication of aortic valve infective endocarditis, associated or not with a perforation of the mitral valve at the base of the aneurysm or its vicinity.2 Two possible mechanisms have been described for the development of an AAML: the first by direct extension of the aortic valve infection to the mitral valve, with abscess formation and subsequent spontaneous drainage; the second by an “infectious seeding” of the anterior mitral leaflet by the regurgitant aortic jet, with

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*

Reprint requests: Manuel Rey, MD, Fundación Jiménez Díaz, Laboratory of Echocardiography, Cardiology Department, Avenida Reyes Católicos n° 2, 28040 Madrid, Spain.

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J Am Soc Echocardiogr 2000;13:1050-2.

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