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.