Abstract
Mitral valve aneurysms (MVAs) are rarely encountered in echocardiography laboratories. Although they are commonly associated with endocarditis of the aortic valve, various mechanisms have been suggested for the etiopathogenesis of MVAs associated with non-infectious conditions. 5,887 patients who underwent transesophageal echocardiography (TEE) between 2007 and 2012 were evaluated retrospectively for MVA. Mitral valve aneurysm is defined as a localized saccular bulging of the mitral leaflet towards the left atrium with systolic expansion and diastolic collapse. The color flow Doppler image of a perforation was described as a high-velocity turbulent jet traversing a valve leaflet in systole. We found that 12 of 5,887 patients (0.204 %) had MVA in TEE examinations. The mean age of patients with MVA was 53 years (range 21–80 years), including four females and eight males. Nine patients presented with symptoms of endocarditis. On TEE, aneurysms were located in the anterior mitral leaflet in 11 patients, and in the posterior mitral leaflet in one patient. Eight patients had severe, three had moderate, and one had trace mitral regurgitation. Of the nine patients with perforated leaflets, eight patients had severe and one patient had moderate mitral regurgitation. Aortic regurgitation was present in nine patients, being severe in three, moderate in two, mild in two, and trace in two patients. Two patients without severe mitral regurgitation were followed-up conservatively, while nine patients underwent surgery. Two patients died from septic shock, one in the postoperative period and the other one prior to surgery. Although MVAs occur during the course of aortic valve endocarditis and, in particular, due to aortic regurgitation jet, it should be borne in mind that they may develop as an isolated valvular pathology and may be misdiagnosed as chordal rupture, other cardiac masses, or vegetation. Thus, MVAs may not be so infrequent as they are thought; they may justify to be considered in the differential diagnosis of masses seen on the mitral valve on echocardiographic examination.
Similar content being viewed by others
References
Rückel A, Erbel R, Henkel B, Krämer G, Meyer J (1984) Mitral valve aneurysm revealed by cross-sectional echocardiography in a patient with mitral valve prolapse. Int J Cardiol 6(5):633–637
Edwards JE (1972) Mitral insufficiency secondary to aortic valvular bacterial endocarditis. Circulation 46:623–626
Gin KG, Boone JA, Thompson CR, Bilbey JH (1993) Conservative management of mitral valve aneurysm. J Am Soc Echocardiogr 6:613–618
Takayama T, Teramura M, Sakai H, Tamaki S, Okabayashi T, Kawashima T et al (2008) Perforated mitral valve aneurysm associated with Libman-Sacks endocarditis. Intern Med 47(18):1605–1608
Edynak GM, Rawson AJ (1963) Ruptured aneurysm of the mitral valve in a Marfan-like syndrome. Am J Cardiol 11:674–677
Lang RM, Bierig M, Devereux RB, Flachskampf FA, Foster E, Pellikka PA et al (2005) Chamber quantification writing group; American society of echocardiography’s guidelines and standards committee; European association of echocardiography. Recommendations for chamber quantification: a report from the American society of echocardiography’s guidelines and standards committee and the chamber quantification writing group, developed in conjunction with the European Association of Echocardiography, a branch of the European Society of Cardiology. J Am Soc Echocardiogr 18(12):1440–1463
Li JS, Sexton DJ, Mick N, Nettles R, Fowler VG Jr, Ryan T et al (2000) Proposed modifications to the Duke criteria for the diagnosis of infective endocarditis. Clin Infect Dis 30:633–638
Vilacosta I, San Román JA, Sarriá C, Iturralde E, Graupner C, Batlle E et al (1999) Clinical, anatomic, and echocardiographic characteristics of aneurysms of the mitral valve. Am J Cardiol 84(1):110–113
Güler A, Hatipoğlu S, Karabay CY, Kırma C (2011) A rare cause of severe mitral regurgitation: mitral valve aneurysm. Turk Kardiyol Dern Ars. 39(8):690–692. doi:10.5543/tkda.2011.01671
Azevedo O, Ferreira F, Guardado J, Durães C, Quelhas I, Pereira A, Almeida J (2010) Mitral and aortic valve aneurysms secondary to infective endocarditis: impressive images of a rare echocardiographic finding. Eur J Echocardiogr. 11(7):E28
González-Lavin L, Lise M, Ross D (1970) The importance of the jet lesion in bacterial endocarditis involving the left heart. J Thorac Cardiovasc Surg 59:185–192
Decroly PH, Vandenbossche JL, Englert M (1989) Anterior mitral aneurysm perforation secondary to aortic valve endocarditis detected by Doppler colour flow mapping. Eur Heart J 10:186–189
English TAH, Honey M, Cleland WP (1972) Ruptured tree aneurysm of mitral valve: a complication of aortic valve endocarditis. Br Heart J 34:434–436
Silbiger JJ (2009) Review: mitral valve aneurysms in infective endocarditis: mechanisms, clinical recognition, and treatment. J Heart Valve Dis 18(5):476–480
Nagai T, Hamabe A, Arakawa J, Konishi T, Hisadome H, Yoshida M, Tabata H, Ito T, Mitsumaru A, Tanaka Y, Uehata A (2013) Mitral valve aneurysm. Ultraschall Med 34(1):69–70
Hong SN, Perk G, Skolnick A, Kronzon I (2009) Evaluation of a posterior mitral valve leaflet aneurysm by real time three-dimensional transesophageal echocardiography. Echocardiography. 26(9):1089–1091
Lee CH, Tsai LM (2006) An aneurysm of posterior mitral valve mimicking a huge vegetation. Int J Cardiol 107(2):277–278
Unger P, Antoine M, Hastir D, Dedobbeleer C, Leeman M (2012) Infective endocarditis presenting as an isolated aneurysm of the posterior mitral leaflet. Can J Cardiol. doi:10.1016/j.cjca.2012.09.010
Işılak Z, Uzun M, Yalçın M, Kılıçarslan F (2013) An adult patient with the ruptured aneurysm of mitral valve posterior leaflet. Anadolu Kardiyol Derg. 13(5):E25
Tewari S, Moorthy N, Sinha N (2010) Ruptured mitral valve aneurysm: an uncommon cause of acute dyspnoea. Echocardiography. 27(10):E119–E121
Almeida-Filho OC, Schmidt A, Sgarbieri R, Marin-Neto JA, Maciel BC (2002) Large submitral left ventricular aneurysm associated with mitral valve aneurysm. Echocardiography. 19(5):391–393
Işık T, Kurt M, Ayhan E, Tanboğa İH (2012) Incidental diagnosis of an aneurysm of the mitral valve posterior leaflet. Anadolu Kardiyol Derg. 12(8):E40–E41
Kim DJ, Cho KI, Jun HJ, Kim YJ, Song YJ, Jhi JH et al (2012) Perforated mitral valve aneurysm in the posterior leaflet without ınfective endocarditis. J Cardiovasc Ultrasound. 20(2):100–102
Ryu YG, Baek MJ (2010) Fibrous skeleton endocarditis causing septated aneurysm on the anterior mitral leaflet. Eur Heart J 31(9):1123
Cai TH, Moody JM Jr, Sako EY (1999) Mitral valve aneurysm due to severe aortic valve regurgitation. Circulation 100(12):e53–e56
Hotchi J, Hoshiga M, Okabe T, Nakakoji T, Ishihara T, Katsumata T et al (2011) Impressive echocardiographic images of a mitral valve aneurysm. Circulation 123(14):e400–e402
Ruparelia N, Lawrence D, Elkington A (2011) Bicuspid aortic valve endocarditis complicated by mitral valve aneurysm. J Card Surg 26(3):284–286
Negishi K, Ono Y, Kurosawa K, Takamatsu H, Nakano A, Hasegawa A et al (2009) Infective endocarditis complicated by mycotic aneurysm of a coronary artery with a perforated mitral valvular aneurysm. J Am Soc Echocardiogr 22(5):542.e1
Aung SM, Güler A, Acar G, Karabay CY, Karagöz A, Sahin M (2011) Aortic valve aneurysm: a result or reason? Anadolu Kardiyol Derg. 11(4):E15
Ohira S, Doi K, Yamano T, Yaku H (2013) Successful repair of a mitral valve aneurysm with cleft of anterior mitral leaflet in an adult. Ann Thorac Surg 96(6):2238–2240
Cziner DG, Rosenzweig BP, Katz ES, Keller AM, Daniel WG, Kronzon I (1992) Transesophageal versus transthoracic echocardiography for diagnosing mitral valve perforation. Am J Cardiol 69:1495–1497
Michelena HI, Suri RM, Enriquez-Sarano M, Dearani J (2010) Ruptured mycotic aneurysm of the mitral valve on real-time 3-dimensional transesophageal echocardiography. J Am Coll Cardiol 56(2):154
Guler A, Aung SM, Kargin R, Bitigen A, Ozdemir N (2011) A hammock in the left atrium. Heart Lung Circ. 20(8):547–549
Valocik G, Allaart CP, Kamp O (1998) Anterior mitral valve aneurysm: evaluation by three-dimensional echocardiography. J Am Soc Echocardiogr 11(6):673–676
Vijay SK, Tiwari BC, Misra M, Dwivedi SK (2014) Incremental value of three-dimensional transthoracic echocardiography in the assessment of ruptured aneurysm of anterior mitral leaflet. Echocardiography 31(1):E24–E26
Stechert MM, Pletcher JR, Tseng EE, London MJ (2012) Echo rounds: aneurysm of the anterior mitral valve. Anesth Analg 114(1):86–88
Goldberg L, Mekel J, Grigorov V (2002) Echocardiographic features of extreme mitral valve prolapse vs mitral valve aneurysm. Cardiovasc J S Afr 13(2):73–77
Conflict of interest
None.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Guler, A., Karabay, C.Y., Gursoy, O.M. et al. Clinical and echocardiographic evaluation of mitral valve aneurysms: a retrospective, single center study. Int J Cardiovasc Imaging 30, 535–541 (2014). https://doi.org/10.1007/s10554-014-0365-4
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10554-014-0365-4