Subannular Mitral Aneurysm and Rheumatic Heart Disease Diagnosed during Postpartum Cardiomyopathy Clinical Case with Literature Review
Introduction: Mitral subvalvular aneurysm is a rare cardiac condition with a significant incidence in Africans. Its association with mitral regurgitation is even rarer. Its origin, not yet clearly established, could be congenital or related to infectious, inflammatory, degenerative, or autoimmune processes.
Case Report: A 28-year-old Congolese woman, married and mother of two, had a history of heart problems, including an episode of acute rheumatic fever requiring a prolonged hospitalization at age 14. There was no subsequent medical follow-up.
One month after her second childbirth, she was hospitalized for rapidly developing exertional dyspnea, followed by persistent dyspnea (NYHA class IV). On admission, she presented with global heart failure, a regular tachycardia of 100 beats/min, and a systolic murmur of mitral regurgitation in the apex of her arm.
The anteroposterior chest X-ray showed cardiomegaly (ICT = 0.67), a mitral-type cardiac silhouette and venous redistribution at the apex. The electrocardiogram revealed a sinus rhythm and hypertrophy of the left cardiac chambers. The Doppler echocardiogram revealed: a subannular mitral aneurysm of the left ventricle, grade 2 mitral regurgitation with thickened leaflets, dilated left ventricular chambers, reduced left ventricular systolic function to 35 per cent, and a minimal pericardial effusion associated with postpartum cardiomyopathy.
Medical treatment for heart failure was successfully administered. The patient was seen at her onemonth follow-up appointment in good haemodynamic condition, although the mitral regurgitation persisted, requiring further monitoring, as did the aneurysm. However, the patient was subsequently lost to follow-up.
Conclusion: The authors emphasise the need to raise awareness amongst clinicians—particularly echocardiographers—of this rare cardiac condition when they are treating young patients presenting with mitral regurgitation and heart failure.