Transesophageal echocardiographic recognition of mitral valve aneurysm

Aneurysm of the mitral valve leaflet is typically a complication of aortic valve endocarditis because of the anatomic relationship between the anterior mitral leaflet and the left ventricular outflow tract. The aortic regurgitant jet or vegetation prolapsing into the left ventricular outflow tract infects the anterior leaflet of the mitral valve. This occurrence has been termed the jet lesion or kissing lesions effect. Transthoracic echocardiography (TTE) and transesophageal echocardiography (TEE) are the preferred diagnostic procedures. Transesophageal echocardiography offers better resolution of mitral valve morphologic characteristics and aneurysmal structure. Herein, we describe a case of infective endocarditis that had the typical features of aortic valve endocarditis coexisting with aortic valve regurgitation and aneurysm of the anterior mitral leaflet, which were diagnosed by TEE.