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. 2013 Jan;25(1):47-51.
doi: 10.1016/j.jsha.2012.11.002. Epub 2012 Nov 24.

Impressive echocardiographic images of a rare pathology: Aneurysm of the mitral valve - Report of two cases and review of the literature

Mustafa A Al-Refai  1 , Farouk M Oueida, Raphael C Lui, Shukri M Al-Saif, Hamed M Al-Omran
Affiliations

Impressive echocardiographic images of a rare pathology: Aneurysm of the mitral valve - Report of two cases and review of the literature

Mustafa A Al-Refai et al. J Saudi Heart Assoc. 2013 Jan.

Abstract

Aneurysm of the mitral valve (AMV) is rarely reported. The etiology of this unusual pathology is commonly attributed to aortic valve endocarditis (AVE) with aortic regurgitation (AR) or connective tissue disease. We present two recent cases of AMV with good correlation between pre-operative trans-esophageal echocardiography (TEE), intra-operative real-time 3-dimensional echocardiography (RT-3D-Echo) and surgical findings. The importance of diligent surveillance by TEE in patients with AVE for occurrence of AMV is emphasized. The literature on this topic is briefly reviewed.

Keywords: Aneurysm; Aortic valve endocarditis; Mitral valve; Real-time 3-dimensional echocardiography; Trans-esophageal echocardiography.

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Figures

Figure 1a
Figure 1a
Patient A, 04/2009 (Ten months before surgery) pre-op TEE showing abnormal “Echo free” space (A) along the mitral-aortic intervalvular fibrosa. MVAL= mitral valve anterior leaflet, LA=Left atrium, LV=Left ventricle.
Figure 1b
Figure 1b
Patient A: 02/2010 pre-op TEE (long-axis view, Systole) showing a bulging aneurysmal sac (AS, surrounded by arrows) arising from the mitral valve anterior leaflet (MVAL), and was divided by an incomplete septum (SEP) into two communicating chambers. R=rupture of the base of MVAL, LA=Left atrium, LV=Left ventricle, RV=Right ventricle.
Figure 1c
Figure 1c
Patient A, 02/2010 pre-op TEE (long-axis view) showing turbulent jet (AJ) from LV to the aneurysmal sac (AS, surrounded by white arrows) during systole, and turbulent regurgitant jet (MRJ) from left ventricle (LV) to left atrium (LA), MVAL = Mitral valve anterior leaflet.
Figure 1d
Figure 1d
Patient A, 02/2010 pre-op TEE showing the aneurismal sac (AS) (white arrows) extending into the left atrial appendex (LAA).
Figure 1e
Figure 1e
Patient A, 02/2010 intra-operative photo showing opened aneurismal sac (black arrows) arising from the anterior leaflet of the mitral valve.
Figure 2a
Figure 2a
Patient B, pre-op TEE (long-axis view) showing early development of an aneurismal sac (AS, white arrows) from the mitral valve anterior leaflet (MVAL), LA=Left atrium, LV=Left ventricle.
Figure 2b
Figure 2b
Patient B, intra-operative RE-3D-Echo showing two small “aneurismal sacs” (white arrows) arising from the mitral valve anterior leaflet.
Figure 2c
Figure 2c
Patient B, intra-operative thoracoscopic photo showing early development of an aneurismal sac (AS) from the mitral valve anterior leaflet (MVAL). The other smaller aneurismal sac seen by the RT-3D-Echo was not evident by this view.
None
See this image and copyright information in PMC

References

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