Mitral valve aneurysm due to severe aortic valve regurgitation.

A33-year-old man presented to the hospital with shortness of breath and chest pain. He was subsequently diagnosed with Streptococcus mitis endocarditis involving the aortic valve. The initial echocardiogram revealed moderate aortic valve regurgitation and a normal mitral valve without regurgitation. The patient was treated with afterload reduction and antibiotics. Blood cultures were negative within 2 days after initiation of antibiotics. He returned to the hospital 1 month later with worsening symptoms, and a repeat echocardiogram showed worsening aortic valve regurgitation. A mitral valve aneurysm was also visualized, with moderate mitral valve regurgitation. The aneurysm was located on the anterior leaflet near the septal commissure and was due to regurgitant blood flow from the aortic valve. Because of worsening of aortic valve regurgitation and refractory symptoms, the patient was referred for surgery. The aortic valve was replaced with a No. 23 St Jude mechanical prosthesis. The mitral valve aneurysm was resected and the defect in the anterior leaflet primarily repaired. A No. 30 Baxter annuloplasty ring was also placed. Pathological evaluation of the aneurysm revealed chronic inflammation without evidence of active endocarditis. The patient recovered uneventfully and was discharged home with anticoagulation.