A 52-year-old man presented to our emergency department with shortness of breath. He reported exertional dyspnea for the past five years which had worsened recently. He reported no weight loss, fever or poor appetite. His past medical history was noncontributory. The physical exam revealed a diastolic murmur best heard in the aortic area. Echocardiography showed a mildly enlarged left ventricle with normal contraction. Severe aortic regurgitation (AR) and holodiastolic flow reversal in the abdominal aorta were present (Figures 1–4). No vegetation was seen on the aortic valve. There was an aneurysmal sac on the anterior leaflet of the mitral valve, corresponding to the site of the high velocity AR jet (video 1 and video 2 in the Supplementary material). Laboratory tests including complete blood cell count, liver and kidney function tests, erythrocyte sedimentation rate and C-reactive protein were normal. The patient refused surgical intervention and was lost to follow-up.
Acquired mitral valve aneurysm is a rare entity which has generally been reported in the context of endocarditis. Aneurysm of the anterior mitral valve leaflet due to the regurgitant flow of AR is a plausible mechanism in the absence of evidence for endocarditis.
Ethical disclosuresProtection of human and animal subjectsThe authors declare that no experiments were performed on humans or animals for this study.
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Conflicts of interestThe authors have no conflicts of interest to declare.