Letter to the Editor Ruptured tricuspid septal leaflet aneurysm in a patient with aortic and mitral valve replacement Uğur Aksu ⁎, Selim Topcu Atatürk University, Faculty of Medicine, Department of Cardiology, Erzurum, Turkey article info Article history: Received 8 April 2015 Accepted 13 April 2015 Available online 15 April 2015 Keywords: Tricuspid septal leaflet aneurysm Infective endocarditis We present a case of ruptured aneurysm of the tricuspid septal leaflet in a patient who had previous history of aortic and mitral valve replacement due to infective endocarditis. The transthoracic echocardi- ography (TTE) showed an aneurysmatic sac under the aortic valve which was associated with septal tricuspid leaflet with a regurgitant systolic jet extending towards the right atrium. Transesophageal echo- cardiography (TEE) showed isolated ruptured tricuspid septal aneu- rysm. Up to our knowledge this is the first case of a ruptured tricuspid septal aneurysm in a patient with aortic and mitral valve replacement [1–4]. A 65-year-old man was admitted to our clinic for routine control for assessment of anticoagulation. He had undergone surgery for aortic and mitral valve replacement due to infective endocarditis 3 years ago. On physical examination, a grade IV/VI systolic murmur was heard at the fourth intercostal space along the right sternal border. His blood pressure was 120/40 mm Hg and his heart rate was 86 beats/min. He was asymp- tomatic and his international normalized ratio was 1.3. TTE revealed normofunctional aortic and mitral mechanical valves. Apical four and five chamber TTE view showed an aneurysmatic dilatation under the aor- tic mechanical valve, associated with tricuspid septal leaflet with a systol- ic jet extending towards the right atrium. TEE showed tricuspid septal leaflet aneurysm and systolic regurgitant jet extending from the right ventricule towards the right atrium via ruptured of leaflet aneurysm (Figs. 1–2 and Movies 1–2). There was no sign of acute infective endocar- ditis on clinical, laboratory and echocardiographic examination. He had been operated due to infective endocarditis 3 years ago and probably this septal leaflet aneurysm was the sequel of the previous infective pro- cess. We decided to follow up the patient with medical therapy, because he was asymptomatic and redo-surgery carried high risk. International Journal of Cardiology 190 (2015) 40–41 ⁎ Corresponding author at: Atatürk University, Faculty of Medicine, Department of Cardiology, Yakutiye Training and Research Hospital, Erzurum, Turkey. E-mail address: aksuuu001@msn.com (U. Aksu). Fig. 1. Tricuspid septal leaflet aneurysm on apical four chamber view. Fig. 2. Systolic regurgitant jet extending from the right ventricule towards the right atrium via ruptured of leaflet aneurysm. http://dx.doi.org/10.1016/j.ijcard.2015.04.089 0167-5273/© 2015 Elsevier Ireland Ltd. All rights reserved. Contents lists available at ScienceDirect International Journal of Cardiology journal homepage: www.elsevier.com/locate/ijcard