Abstract

Background: Mitral valve aneurysms (MVAs) are uncommon conditions frequently associated with aortic valve endocarditis. They may be complicated by perforation and severe mitral regurgitation (MR). Optimal treatment of MVA, and in particular the best timing for surgery, are uncertain.

Case Presentation: We report three cases of MVAs complicating aortic valve endocarditis:

Case 1: A 56-year-old male with acute pulmonary edema secondary to severe aortic and mitral regurgitation underwent emergency double valve replacement. Despite initial postoperative stability, he later succumbed to complications.

Case 2: A 33-year-old female developed severe regurgitation of both valves and multiple cerebral infarctions post-febrile illness. Due to the COVID-19 pandemic, her double valve replacement was delayed, but she recovered well after surgery.

Case 3: A 41-year-old male, initially evaluated for renal transplant, was incidentally found to have severe aortic regurgitation and MVA. He successfully underwent elective aortic valve replacement and mitral valve repair.

Details: The first patient had Severe AR and MR, presented with pulmonary edema, and underwent double valve replacement. The second patient had a prolonged course of relapsing and remitting fever for one and half years which was initially treated by broad-spectrum antibiotics, complicated by CVA, had severe MR and AR, and underwent double valve replacement. The third patient had unexplained pulmonary edema even after regular dialysis and as a pre-operative check-up had AV endocarditis with MVA causing severe AR and MR   and underwent AVR with MV repair. All patients had mechanical valves for replacement and MV repair by pericardial patch.

Conclusions: MVAs are infrequent but potentially severe complications of AV endocarditis. In the absence of definite treatment indications, the correct time for surgery should depend on concomitant clinical and infective features.