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Three years before admission a 19 year old man underwent prosthetic aortic valve replacement for congenital aortic stenosis. A patch enlargement of the aortic valve ring was performed through extension of the aortic incision into the anterior mitral leaflet. Postoperatively a mild mitral regurgitation was noticed.
At presentation the patient complained of weakness and lack of energy. A right sided pericardial mass was seen on routine chest x ray. Transoesophageal echocardiography revealed a severe mitral regurgitation caused by a defect in the base of the anterior mitral leaflet (left panel). Contrast enhanced magnetic resonance imaging demonstrated an aneurysm of the right inferior pulmonary vein (middle panel). The regurgitation jet was directed to the dilated pulmonary vein. Mitral valve repair was performed with an additional Dacron patch. Six months later, there is no residual mitral insufficiency and the aneurysm has completely disappeared (right panel). The patient is free of symptoms.