Abstract

Spontaneous mitral leaflet perforations are rare. We are reporting a 60 year old hypertensive female patient admitted with pulmonary edema with clinically short systolic murmur at apex without ischemic changes on ECG. There is no h/o chest pain, fever, blunt trauma of chest. TTE no RWMA, good bi- ventricular function, a posteriorly directed eccentric moderate – severe mitral regurgitation, normal LA, LV, no vegetation or prolapsed. TEE after stabilization showed whole in body of AML at its midpoint leading to severe regurgitant jet in to LA with Vena contracta of 0.8 mm. All the papillary muscles were intact and there is no prolapse of leaflets and no vegetation. Cardiac catheterization revealed increased LVEDP and PCWP with mild PAH with normal coronary arteries.