[triple Rupture of Aneurysm of the Mitral Valve in Subacute Bacterial Endocarditis].

The commonest form of cardiac valvular aneurysm is the thrombo-aneurysm of Ribbert (1924), which arises by perforation of an ulcer of the valve cusp into a hollow thrombotic mass and by organization undergoes fibrosis of varying degree. Reports of such aneurysms are not infrequent in the early reports of bacterial endocarditis, but aneurysms having well-organized, smooth, fibrous walls are rare; Saphir and Leroy (1945) believe that some of them are true aneurysms resulting from the action of intra-ventricular pressure upon a portion of valve cusp weakened by valvulitis. The aneurysms affect the aortic valve more commonly than the mitral (Pelvet, 1867; Osler, 1908; Horder, 1909; von Arx, 1914; Soulie and Porge, 1937), and involve the anterior (aortic or right) cusp of the mitral valve much more often than the posterior. Habershon in 1855 described a smooth-walled aneurysm, 1P9 cm. in diameter, affecting the aortic cusp of the mitral valve, and Ogle (1858 a and b) described two smaller examples. Of the 23 cardiac valvular aneurysms collected by Pelvet, 9 affected the mitral valve. More recent instances of mitral valvular aneurysms are those of Horder (1909, Fig. 14), Calwell (1912), von Arx (1914), Whimster (1928), Pichon and Bidou (1932), Soulie and Porge (1937), Soulie et al. (1947), Saphir and Leroy (1948), Libman and Friedberg (1948), and Musallam and McCall (1953). In this paper we report an extreme example of aneurysmal deformity of the mitral valve in a patient who survived for five years after an attack of subacute bacterial endocarditis treated with penicillin, and a further case that illustrates some aspects of the pathogenesis of the lesion.