A Calcified Amorphous Tumor Causing Mitral Valve Perforation and Ruptured Chordae Tendineae / 日本心臓血管外科学会雑誌

Calcified amorphous tumor (CAT) is a non-neoplastic mass characterized by calcified nodules that was first reported in 1997. It is often associated with dialysis or mitral annular calcification (MAC). CAT is considered a risk factor for systemic embolism, but there has been no report of CAT damaging the native valve tissue and leading to valvular disease. An 81-year-old woman had shortness of breath on exertion starting 1 year previously, and was referred to our hospital with cardiac murmur detected on physical examination. Echocardiography showed evidence of severe mitral valve regurgitation with ruptured chordae tendineae of the posterior leaflet and a poorly mobile club-shaped structure protruding into the left ventricle and appearing to be continuous with MAC. She underwent elective mitral valve repair. A club-shaped calcification originating from MAC was found under the P2 segment, with ruptured P2 chordae tendineae immediately above it and mitral perforation in the contralateral A2 segment, which were likely to have resulted from direct damage by the hard structure. Mitral valve repair was successful with mass resection, triangular resection of the posterior leaflet P2 segment, and closure of the perforation. Histopathological findings of the mass were consistent with CAT, with no evidence of infection or malignancy. CAT may not only cause embolism but also grow while damaging the native valve tissue. It is important to closely follow-up and perform surgery in proper timing.

A Case of Infective Endocarditis Complicated with Multiple Myocotic Aneurysm and Mitral Valve Perforation

Mycotic aneurysm, uncommon complication of infective endocarditis (IE), develope more often in patients with subacute IE than acute IE. We report an unusual case of acute endocarditis complicated with multiple mycotic aneurysm and mitral valve perforation. 42 year old man who are referred for management of uncontrolled fever and dyspnea was diagnosed as acute mitral valve infective endocarditis caused by Staphylococcus aureus. He got complication of mycotic aneurysm on right femoral artery and mitral valve perforation with severe mitral regurgitation during favorable course of antibiotic treatment. Mycotic aneurysm was successfully treated with endovascular coil insertion and thrombin injection and mitral valve replacement was performed. On second day after operation, he died due to catastrophic intracranial hemorrhage which suggests another mycotic aneurysm rupture.

Anterior Mitral Leaflat Perforation in Patients with Bicuspid Aortic Valve Endocarditis

Mitral valve perforation is a rare cause of severe mitral regurgitation, which occurs most commonly as a secondary involvement of aortic valve endocarditis. The probable mechanisrns are direct extension of the infection from the aortic valve, infected aortic regurgitant jet striking the ventricular surfaces of the mitral-aortic intervalvular fibrosa(MAIVF) and the anterior mitral leaflet(AML). Early recognition of these subaortic complications in patients with aortic valve endocarditis is important because (1) these complications may produce severe mitral regurgitation and hemodynamic collapse, (2) the presence of severe mitral valve involvement may present as primary mitral valve disease, (3) these complications can be overlooked during aortic valve replacement, and (4) cause difficulty in valve replacement and high mortality. We report two cases of AML perforation observed in patients with bicuspid aortic valve endocarditis.