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Anterior mitral valve aneurysm: a rare sequelae of aortic valve endocarditis

Rajesh Janardhanan1, Muhammad Umar Kamal2, Irbaz Bin Riaz2

  • 1Department of Cardiology, Sarver Heart Center, Banner University Medical Center, Tucson, Arizona, USA raj@shc.arizona.edu.

Echo Research and Practice
|June 2, 2016
PubMed
Abstract

Insights

Infective endocarditis in intravenous drug users can affect the left side of the heart, leading to rare mitral valve aneurysms. Early diagnosis with real-time 3D-transesophageal echocardiography is crucial for managing this complication.

Area of Science:

  • Cardiology
  • Infectious Diseases
  • Medical Imaging

Background:

  • Infective endocarditis (IE) in intravenous drug abusers (IDUs) typically affects right-sided valves, with Staphylococcus aureus as the common pathogen.
  • Left-sided IE in IDUs is less common but can lead to severe complications.

Observation:

  • A case of left-sided IE caused by Enterococcus faecalis in an IDU is presented.
  • The patient developed an anterior mitral valve aneurysm, an exceptionally rare complication of IE.
  • A literature review identified only five prior cases of mitral valve aneurysmal rupture associated with E. faecalis endocarditis.

Findings:

  • Real-time 3D-transesophageal echocardiography (RT-3DTEE) proved critical for accurate diagnosis of the mitral valve aneurysm.
  • Mitral valve aneurysms (MVAs) pose a risk of rupture, leading to severe mitral regurgitation (MR) and requiring emergency surgery.
  • MVAs may be overlooked during aortic valve replacement (AVR) if not accurately diagnosed.

Implications:

  • Early recognition and diagnosis of MVAs are vital for timely intervention in critically ill patients.
  • RT-3DTEE offers superior accuracy for MVA diagnosis and management compared to traditional echocardiography.
  • This case highlights the importance of considering left-sided IE and its rare complications in IDUs.

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