Anterior mitral valve perforation in the absence of acute infection: Diagnosis by two‐dimensional and three‐dimensional transesophageal echocardiography

Abstract

Anterior mitral valve leaflet (AMVL) perforation is most commonly seen in the setting of infective endocarditis. We present a case of AMVL perforation in a previously healthy 62-year-old male who presented with a six-month history of worsening dyspnea and peripheral edema. Blood cultures, inflammatory markers, and autoimmune profile were negative. Transthoracic echocardiography demonstrated severe mitral regurgitation (MR) with a possible AMVL perforation, which was confirmed by three-dimensional transesophageal echocardiography as a well-circumscribed hole in the A2 segment. The patient made a successful recovery from mitral valve repair surgery.

Expanding percutaneous treatment of mitral valve diseases: Transcatheter closure of mitral valve leaflet perforation

“…In our patient, MR regurgitation was due to a perforation of the anterior leaflet. Infective endocarditis, connective tissue disease or an aortic regurgitation are potential causes of mitral valve perforation, but the patient had no history of infective endocarditis or any other underlying medical conditions that might explain the perforation 3,4 . Hence, iatrogenic injury from previous cardiac surgery over the left ventricular tract obstruction was considered, probably due to inadvertent damage to the mitral valve in the last surgery 5 .…”

“…3‐D TEE (especially zoom 3‐D, live and multiplanar reconstruction or MPR) is able to define the presence, location and shape of the orifice and played a key role in both the diagnosis and monitoring of the disease. Multiple 2‐D and 3‐D images may be required 3 . The location of the defect, their shape (round, oblong, and elliptical) and size need to be ascertained precisely, because these parameters determine which occluder device will be used, and the size of the device as well.…”

Be Prepared for the Unexpected

“…Speculating the underlying etiology for the patient’s mitral valve perforation is also fascinating. Although infective endocarditis is the commonest cause, other possibilities limited to case reports include iatrogenic from cardiac surgery or interventions, connective tissue disease, aortic regurgitation jet, congenital mitral valve malformations, and spontaneous perforation ( 6 , 7 ). The etiology in our case was not immediately obvious, in the absence of previous diagnosis of all of the previously listed conditions or left heart surgery.…”

Coexistence of Aortic Pseudocoarctation and Mitral Valve Perforation in a Patient With Takayasu’s Arteritis: Coincidence or Association?

“…The pathogenesis of this disease remains unclear. 4,5 The clinical course of TA is thought to progress through nonspecific systemic symptoms such as fatigue, low-grade fever, and weight loss, and depending on the vessels involved, through a wide variety of vascular or ischemic manifestations. 6,7 Aortic coarctation and TA have clinical similarities which should be kept in mind during diagnostic work up.…”