Impressive Echocardiographic Images of a Mitral Valve Aneurysm
2011; Lippincott Williams & Wilkins; Volume: 123; Issue: 14 Linguagem: Inglês
10.1161/circulationaha.110.984799
ISSN1524-4539
AutoresJunko Hotchi, Masaaki Hoshiga, Taichi Okabe, Takahiro Nakakoji, Tadashi Ishihara, Takahiro Katsumata, Toshiaki Hanafusa,
Tópico(s)Infective Endocarditis Diagnosis and Management
ResumoHomeCirculationVol. 123, No. 14Impressive Echocardiographic Images of a Mitral Valve Aneurysm Free AccessBrief ReportPDF/EPUBAboutView PDFView EPUBSections ToolsAdd to favoritesDownload citationsTrack citationsPermissions ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toFree AccessBrief ReportPDF/EPUBImpressive Echocardiographic Images of a Mitral Valve Aneurysm Junko Hotchi, Masaaki Hoshiga, Taichi Okabe, Takahiro Nakakoji, Tadashi Ishihara, Takahiro Katsumata and Toshiaki Hanafusa Junko HotchiJunko Hotchi From the First Department of Internal Medicine (J.H., M.H., T.O., T.N., T.I., T.H.) and Department of Thoracic and Cardiovascular Surgery (T.K.), Osaka Medical College, Takatsuki, Osaka, Japan. , Masaaki HoshigaMasaaki Hoshiga From the First Department of Internal Medicine (J.H., M.H., T.O., T.N., T.I., T.H.) and Department of Thoracic and Cardiovascular Surgery (T.K.), Osaka Medical College, Takatsuki, Osaka, Japan. , Taichi OkabeTaichi Okabe From the First Department of Internal Medicine (J.H., M.H., T.O., T.N., T.I., T.H.) and Department of Thoracic and Cardiovascular Surgery (T.K.), Osaka Medical College, Takatsuki, Osaka, Japan. , Takahiro NakakojiTakahiro Nakakoji From the First Department of Internal Medicine (J.H., M.H., T.O., T.N., T.I., T.H.) and Department of Thoracic and Cardiovascular Surgery (T.K.), Osaka Medical College, Takatsuki, Osaka, Japan. , Tadashi IshiharaTadashi Ishihara From the First Department of Internal Medicine (J.H., M.H., T.O., T.N., T.I., T.H.) and Department of Thoracic and Cardiovascular Surgery (T.K.), Osaka Medical College, Takatsuki, Osaka, Japan. , Takahiro KatsumataTakahiro Katsumata From the First Department of Internal Medicine (J.H., M.H., T.O., T.N., T.I., T.H.) and Department of Thoracic and Cardiovascular Surgery (T.K.), Osaka Medical College, Takatsuki, Osaka, Japan. and Toshiaki HanafusaToshiaki Hanafusa From the First Department of Internal Medicine (J.H., M.H., T.O., T.N., T.I., T.H.) and Department of Thoracic and Cardiovascular Surgery (T.K.), Osaka Medical College, Takatsuki, Osaka, Japan. Originally published12 Apr 2011https://doi.org/10.1161/CIRCULATIONAHA.110.984799Circulation. 2011;123:e400–e402A 77-year-old woman with a fractured femur was referred to our hospital because preoperative echocardiography raised suspicion of a mitral valve tumor. She had no history of unknown fever or heart murmur. Transthoracic and transesophageal echocardiography showed severe mitral regurgitation and aortic regurgitation. A mobile lesion that appeared to be a cystic tumor (14×15 mm) was on the posterior mitral leaflet (Figure 1 and Movie in the online-only Data Supplement). The lesion had no color Doppler signal inside. Computed tomography showed a cystic mass with homogeneously enhanced contents (Figure 2). During the period of recovery from her hip surgery, the patient developed a sporadic febrile illness, and Enterococcus faecium was cultured from a blood sample. Antibiotics were administered for 3 weeks, after which the aortic and mitral valves were replaced. The size of mass on the mitral valve and the severity of mitral regurgitation or aortic regurgitation did not change. At operation, a large valve aneurysm (16×19 mm) was found on the posterior leaflet of the mitral valve (Figure 3). The mitral valve leaflets were redundant and prolapsed. Histopathological examination of the valve aneurysm showed destruction of the valve layers, neovascularization, and widespread perivascular infiltration of inflammatory cells such as lymphocytes (Figure 4), suggestive of latent infective endocarditis.1 Myxomatous degenerative change was also found in both the aneurysmal and nonaneurysmal portions of the mitral valve. Cultures of the native valves were negative for bacteria.Download figureDownload PowerPointFigure 1. Preoperative echocardiography showing the cystic tumor of the posterior mitral valve leaflet (yellow arrow) bulging toward the left ventricle in diastole (A) and toward the left atrium in systole (B) C, Color Doppler echocardiogram showing 2 mitral regurgitant jets; one (open arrowhead) was caused by prolapse of the lateral segment of the posterior leaflet, and the other (closed white arrowhead) was caused by prolapse of the medial segment of the posterior leaflet (D).Download figureDownload PowerPointFigure 2. Axial images from a 320-multislice computed tomography of the heart. Precontrast (A) and postcontrast (B) images showing a well-demarcated, homogeneously enhanced tumor with a diameter of 15 mm in the left atrium (LA). LV indicates left ventricle. Arrowheads indicate the edge of the tumor.Download figureDownload PowerPointFigure 3. Surgically excised mitral valve. A large aneurysm (16×19 mm; arrowhead) was found on the posterior mitral valve.Download figureDownload PowerPointFigure 4. Histology of the mitral valve aneurysm. Staining of the resected mitral valve aneurysm with hematoxylin and eosin (A) and elastic van Gieson (B) showed destruction of the valvular structure. Scale bar, 10 mm. The thickened mitral valve is denoted by asterisks, and the area above the asterisks corresponds to the valve aneurysm. A and B show a cross-sectional view of the mitral valve along the dotted line in C. D, High-magnification view of the boxed area A reveals infiltration of lymphocytes and neovascularization. Scale bar, 10 μm.Mitral valve aneurysm is frequently found in the anterior leaflet and associated with infective endocarditis. The probable mechanism of aneurysm formation is mycotic destruction of the leaflet structure or myxomatous degeneration.1,2 In addition, the existence of aortic regurgitation jet or eccentric mitral regurgitation jet striking the leaflet of the mitral valve could lead to infective endocarditis.3 However, in this patient, the mitral aneurysm was in the posterior leaflet, which was not struck by a jet. We think that weakness of the mitral valve secondary to myxomatous degeneration and latent infective endocarditis1 caused the aneurysm.DisclosuresNone.FootnotesThe online-only Data Supplement is available with this article at http://circ.ahajournals.org/cgi/content/full/123/14/e400/DC1.Correspondence to Masaaki Hoshiga, MD, FAHA, First Department of Internal Medicine, Osaka Medical College, 2–7 Takatsuki, Osaka 569-8686, Japan. E-mail [email protected]osaka-med.ac.jpReferences1. Kawai S, Oigawa T, Sunayama S, Yamaguchi H, Okada R, Hosoda Y, Sawada H, Aoki K, Furuta S, Kato K, Sunamori M, Takamoto T, Shirai T, Amano JMitral valve aneurysm as a sequela of infective endocarditis: review of pathologic findings in Japanese cases. J Cardiol. 1998; 31 (suppl 1): 19–36MedlineGoogle Scholar2. Edwards JE. Mitral insufficiency secondary to aortic valvular bacterial endocarditis. Circulation. 1972; 46:623–626LinkGoogle Scholar3. Gao C, Xiao C, Li B. Mitral valve aneurysm with infective endocarditis. Ann Thorac Surg. 2004; 78:2171–2173CrossrefMedlineGoogle Scholar Previous Back to top Next FiguresReferencesRelatedDetailsCited By Kakino T, Sakamoto I, Nishizaki A, Ishikita A, Ishikita A, Sonoda H, Shiose A and Tsutsui H (2023) Right-Sided Endocarditis With Mitral Valve Aneurysm, Circulation Journal, 10.1253/circj.CJ-22-0497, 87:2, (379), Online publication date: 25-Jan-2023. Maidman S, Kiefer N, Bernard S, Freedberg R, Rosenzweig B, Bamira D, Vainrib A, Ro R, Neuburger P, Basu A, Moreira A, Latson L, Loulmet D and Saric M (2021) Native mitral valve staphylococcus endocarditis with a very unusual complication: Ruptured posterior mitral valve leaflet aneurysm, Echocardiography, 10.1111/echo.15254, 39:1, (112-117), Online publication date: 1-Jan-2022. Galzerano D, Kinsara A, Di Michele S, Vriz O, Fadel B, Musci R, Galderisi M, Al Sergani H and Colonna P (2020) Three dimensional transesophageal echocardiography: a missing link in infective endocarditis imaging?, The International Journal of Cardiovascular Imaging, 10.1007/s10554-019-01747-x, 36:3, (403-413), Online publication date: 1-Mar-2020. Nini Gupta P (2018) An unusual cystic mass in the left atrium/what is it?, MOJ Clinical & Medical Case Reports, 10.15406/mojcr.2018.08.00258, 8:3 Yan J, Zhang F, Liang Y and Sun J (2018) Anterior Mitral Valve Aneurysm Comparative Cardiac Imaging, 10.1002/9781119453192.ch62, (341-344) Wu W, Ma L, Yang X, Yan B and Sun J (2018) Dual Aortic and Mitral Valve Aneurysms in a Patient with Infective Endocarditis Comparative Cardiac Imaging, 10.1002/9781119453192.ch56, (317-320) Afonso L, Kottam A, Reddy V and Penumetcha A (2017) Echocardiography in Infective Endocarditis: State of the Art, Current Cardiology Reports, 10.1007/s11886-017-0928-9, 19:12, Online publication date: 1-Dec-2017. Konishi T, Funayama N, Yamamoto T, Hotta D, Kikuchi K, Ohori K, Nishihara H and Tanaka S (2016) Severe mitral regurgitation due to mitral leaflet aneurysm diagnosed by three-dimensional transesophageal echocardiography: a case report, BMC Cardiovascular Disorders, 10.1186/s12872-016-0413-1, 16:1, Online publication date: 1-Dec-2016. Janardhanan R, Kamal M, Riaz I and Smith M (2016) Anterior mitral valve aneurysm: a rare sequelae of aortic valve endocarditis, Echo Research & Practice, 10.1530/ERP-16-0003, 3:1, (K7-K13), Online publication date: 1-Mar-2016. Seratnahaei A, Bailey A, Hensley P, O'Connor W and Smith M (2015) Infective Endocarditis Complicated by Mitral Valve Aneurysm: Pathologic and Echocardiographic Correlations, Echocardiography, 10.1111/echo.12958, 32:9, (1417-1422), Online publication date: 1-Sep-2015. Guler A, Karabay C, Gursoy O, Guler Y, Candan O, Akgun T, Bulut M, Pala S, Izgi A, Esen A, Kirma C and Ozkan M (2014) Clinical and echocardiographic evaluation of mitral valve aneurysms: a retrospective, single center study, The International Journal of Cardiovascular Imaging, 10.1007/s10554-014-0365-4, 30:3, (535-541), Online publication date: 1-Mar-2014. Al-Refai M, Oueida F, Lui R, Al-Saif S and Al-Omran H (2013) Impressive echocardiographic images of a rare pathology: Aneurysm of the mitral valve – Report of two cases and review of the literature, Journal of the Saudi Heart Association, 10.1016/j.jsha.2012.11.002, 25:1, (47-51), Online publication date: 1-Jan-2013. Kim D, Cho K, Jun H, Kim Y, Song Y, Jhi J, Chon M, Kim S, Lee H and Kim T (2012) Perforated Mitral Valve Aneurysm in the Posterior Leaflet without Infective Endocarditis, Journal of Cardiovascular Ultrasound, 10.4250/jcu.2012.20.2.100, 20:2, (100), . April 12, 2011Vol 123, Issue 14 Advertisement Article InformationMetrics © 2011 American Heart Association, Inc.https://doi.org/10.1161/CIRCULATIONAHA.110.984799PMID: 21482969 Originally publishedApril 12, 2011 PDF download Advertisement SubjectsEchocardiography
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