Case Report
Due to recurrent chest tightness and shortness of breath, the patient came to the emergency department of our hospital. Transthoracic echocardiography revealed mitral leaflet cystic nodules, suspected benign tumor or infective endocarditis with vegetations, and mitral valve with severe regurgitation. The patient had no other comorbidities except hypertension. Systolic murmur in apical region was heard. Transesophageal echocardiography revealed the presence of multiple cystic structures with significant separation in the A1, C1, and P1 leaflets of the mitral Carpentier nomenclature1. The larger one was located in the P1 area, about 18.3*14.2mm in size, and smaller in the A1 area about 9.9*5.4mm (Figure 1). The conclusion of ultrasonography showed that primary valve tumor should be considered first after excluding infective endocarditis. We had done a lot of examinations related to infective endocarditis, such as cranial Computed Tomography (CT), brain magnetic resonance imaging (MRI) and blood culture, etc. But our case did not fulfill the modified Duke criteria for the clinical diagnosis of infective endocarditis. Then we planned to perform valve tumor resection and mitral valve repair. However, no tumors were occupied and no infectious vegetations were found on the valve leaflets during the operation. The cystic structure described by ultrasound was caused by prolapse due to leaflet degeneration (Figure 2). In order to maintain the integrity of the leaflet structure, we performed folding repair for the mitral leaflet. The patient was recovered well after operation, and the result of echocardiography evaluation was satisfactory.