MITRAL-VALVE ANEURYSM AND INFECTIVE ENDOCARDITIS - REPORT OF 4 CASES

From March 1992 to March 1994, four cases of mitral valve aneurysm wer e diagnosed at National Taiwan University Hospital. Mitral valve infec tive endocarditis was documented in three patients, while aortic valve infective endocarditis was found in the other. The diagnosis of mitra l valve aneurysm was based on characteristic echocardiographic finding s. The mitral valve aneurysms in these four cases were all visualized by transesophageal but not transthoracic echocardiography. At the time of diagnosis, three patients with a history of mitral valve endocardi tis had perforated mitral valve aneurysms and severe mitral regurgitat ion. Although not found before surgery, the remaining patient with a h istory of aortic valve endocarditis was noted to have an unperforated mitral valve aneurysm one month after aortic valve replacement. All th ree patients with severe mitral regurgitation underwent mitral valve r eplacement and the patient with an unperforated mitral valve aneurysm was managed conservatively and obtained a stable clinical condition. I n conclusion, mitral valve aneurysm usually appears to be associated w ith infective endocarditis and transesophageal echocardiography is mor e helpful in the diagnosis of mitral valve aneurysm than transthoracic echocardiography. Furthermore, unperforated mitral valve aneurysms ma y be managed conservatively with careful follow-up.