Spontaneous Healing Of A Ruptured Mycotic Aneurysm Of The Posterior Mitral Leaflet: Unexpected Resolution Of A Severe Mitral Regurgitation
Ruisanchez Villar, C., Gonzalez Lizarbe, S., Lerena Saenz, P., Gil Ongay, A., Borderias Villarroel, T., Teira Calderon, A., Cabrera Rubio, I., & Cuesta Cosgaya, J. M. (2021). Spontaneous healing of a ruptured mycotic aneurysm of the posterior mitral leaflet: Unexpected resolution of a severe mitral regurgitation. Echocardiography (Mount Kisco, N.Y.), 38(4), 681–685. https://doi.org/10.1111/echo.14999
View Original Source →Abstract
Mycotic mitral valve aneurysm is an uncommon complication that rarely appears in isolated mitral valve endocarditis. The weakened aneurysmal wall may rupture, causing severe mitral regurgitation. In this situation surgery is essential. We present a case of a rare complicated mycotic posterior mitral aneurysm. After completing the antibiotic course for Streptococcus agalactiae infective endocarditis, an unexpected healing process within the aneurysm led to the virtual disappearance of the mitral regurgitation and remarkably changed the patient's clinical outcome. We emphasize the key role of three-dimensional transesophageal echocardiography, as it is becoming the reference imaging technique for infective endocarditis.
Case Details
Disease Location
Heart
Personal Characteristics
77-year-old female
Clinical Characteristics
Fever and fatigue. Blood tests showed leukocytosis, significantly elevated inflammatory markers and acute renal failure. Holosystolic murmur was present on cardiac apex auscultation. Streptococcus agalactiae was isolated from repeated blood cultures. Echocardiogram revealed posterior mitral valve (pmv) prolapse associated with multiple vegetations and chordal rupture. Moderate mitral regurgitation was present. A six-week course of intravenous antibiotics was initiated. Forth-week 3d-tee highlighted the disappearance of vegetations but also a ruptured mycotic aneurysm of the pmv leaflet causing severe massive mr through the leaflet. Mitral annulus and anterior mitral valve leaflet were preserved, as was the aortic valve
Remission Characteristics
Three months later, 3d-tee revealed a cicatrization process of the posterior mitral valve aneurism and leaflet, resulting in an almost total disappearance of the mitral regurgitation
Treatment & Mechanisms
Clinical Treatment
IV antibiotics