In, Oh JK, Seward JB Tajik AJ ed. The Echo Manual, 3rd ed, Lippinco Williams
and Wilkins,. Philadelphia 2006:243-250. *Head, Department of Cardiology, ...
Pictorial CME
Aneurysm of Mitral Valve SR Mi al*
Fig. 1 : Transesophageal four chamber view showing vegetation over anterior mitral leaflet (V) and aneurysm of anterior mitral leaflet
Fig. 2 : Transesophageal echocardiogram showing communication of aneurysm with left ventricular cavity
Fig. 3 : Colour Doppler study showing flow of blood from LV into the mitral valve aneurysm
A 45 years old male presented with breathlessness. He was a known case of mitral and aortic regurgitation. He was treated at some other center for culture positive endocarditis but stopped treatment after nine days. Transthoracic echocardiography revealed large vegetation on anterior mitral leaflet and moderate mitral regurgitation and aortic regurgitation. Transesophageal echocardiography confirmed vegetation on anterior mitral leaflet but in addition revealed an aneurysm of anterior mitral leaflet (Fig 1). It was communicating with left ventricular cavity (Fig 2). Colour doppler imaging confirmed communication of aneurysm with LV cavity (Fig 3). Aneurysm is an echolucent space that is contiguous with the cavity of origin and is completely bounded by a thin layer of tissue extending from the cavity of origin.1 Aneurysms of cardiac valve are usually a part of infective endocarditis. Rarely such aneurysms can occur without any evidence of infective endocarditis. They are considered to represent congenital malformation. Transesophageal echocardiography with colour Doppler evaluation is more sensitive than transthoracic echocardiography in detecting intracardiac fistulas, valve leaflet perforation and aneurysm.1 Mitral valve aneurysms occur most commonly at the base of anterior leaflet and protrude into left atrium.2 It may be present even in absence of vegetations.3 It may perforate into the left atrium resulting in additional acute mitral regurgitation.
References 1.
Sachdev M, Peterson GE, Jollis JG. Imaging techniques for diagnosis of infective endocarditis. Infect Dis Clin North Am 2002;16:319-337.
2.
Feigenbaum H, Armstrong WF, Ryan T. Mitral valve disease. In Feigenbaum H, Armstrong WF, Ryan T ed. Feigenbaum’s Echocardiography, 6th ed, Lippinco Williams and Wilkins, Philadelphia 2005:306-351.
3.
Oh JK, Seward JB, Tajik AJ. Infective endocarditis. In, Oh JK, Seward JB Tajik AJ ed. The Echo Manual, 3rd ed, Lippinco Williams and Wilkins, Philadelphia 2006:243-250.
*
Head, Department of Cardiology, St. Francis Hospital, Beawer Road, Ajmer. Received: 22.04.2010; Accepted: 21.07.2010
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