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Mycotic Coronary Artery Aneurysm and Mitral Valve Regurgitation Caused by Infectious Endocarditis

A 60-year-old female with a history of mitral regurgitation and infectious endocarditis presented with atrial fibillation and a 5.5 cm 5 cm mass on the posterior surface of the heart on computed tomography (CT) scan (Fig. 1A) and severe mitral regurgitation on echocardiogaphy. Coronary angiography showed the mass was supplied from vessels from a branch of the left circumflex artery. Cardiac magnetic resonance imaging showed no contrast enhancement of the mass (Figs. 1B–D). At the time of surgery following a median sternotomy, standard cannulation, and cardioplegic arrest, the mass was found posterior to the left atrium (Fig. 2A). The mass was incised, the thrombus removed, and an inflow vessel from an atrial branch was ligated. The mitral valve was exposed through a superior transseptal approach and was found to have chordal rupture of P1 and P3 and a perforation of the leaflet at P2 (Fig. 2B). Thiswas repairedwith a triangular resection, Gore-Tex (WL Gore & Associates, Flagstaff, AZ, USA) artificial chords, an autologous pericardial patch, and a 38mm Physio II annuloplasty ring (Edwards Lifesciences, Irvine, CA, USA). The patient tolerated the procedure well and a followup echo showed only trivial mitral regurgitation.