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(Circulation. 2000;102:2159.)
© 2000 American Heart Association, Inc.

Images in Cardiovascular Medicine

Severe Mitral Regurgitation After Valve Replacement as Cause of Pulmonary Venous Aneurysm

Steffen P. Christow, MD; Rainer Dietz, MD

From the Franz Volhard Clinic and Max-Delbrück Center for Molecular Medicine, Charité, Campus Berlin-Buch, Humboldt University of Berlin, Berlin, Germany.

Correspondence to Steffen P. Christow, MD, Franz Volhard Clinic, Charité, Campus Berlin-Buch, Wiltbergstraße 50, 13125 Berlin, Germany. E-mail christow@fvk-berlin.de

A4 9-year-old man was referred because of an acute myocardial infarction. He had undergone aortic and mitral valve replacements for endocarditis in 1984 (Figure 1). In the early 1990s, the mitral valve had developed a paravalvular leak that was not regarded as consequential. A right-sided mass was noted on the chest roentgenogram, however, that was interpreted as a pericardial "cyst." The patient denied trauma, vasculitis, syphilis, and chronic granulomatous diseases and had not been known to have a pericardial cyst previously. On admission, the chest roentgenogram demonstrated cardiomegaly and a well-circumscribed circular mass adjacent to the right cardiac border (Figure 2). Transthoracic echocardiography demonstrated an enlarged right pulmonary vein (Figure 3, arrows). Color Doppler studies revealed 2 paravalvular leaks flanking the mitral valve prosthesis; the larger septal jet extended into the right pulmonary vein. CT confirmed the presence of a true aneurysm involving the right inferior pulmonary vein (Figure 4, arrows).

View larger version (126K): [in this window] [in a new window]   Figure 1. Chest roentgenogram 2 years after double valve replacement showing normal right cardiac border.

View larger version (94K): [in this window] [in a new window]   Figure 2. Chest roentgenograms on admission showing cardiomegaly and circular lesion adjacent to right cardiac border (arrows). On lateral view, mass is located above right diaphragm at midmediastinal level.

View larger version (37K): [in this window] [in a new window]   Figure 3. Transthoracic echocardiogram showing enlarged right pulmonary vein (arrows). Color Doppler revealed 2 jets; larger septal jet extends into pulmonary vein.

View larger version (117K): [in this window] [in a new window]   Figure 4. CT showing true aneurysm involving right inferior pulmonary vein. LA indicates left atrium.

True aneurysms of the pulmonary vein are rare, and little is known about their pathogenesis.¹ However, an association between such aneurysms and . . . [Full Text of this Article]