Anterior mitral valve perforation in the absence of acute infection: Diagnosis by two‐dimensional and three‐dimensional transesophageal echocardiography

Anterior mitral valve leaflet ( AMVL ) perforation is most commonly seen in the setting of infective endocarditis. We present a case of AMVL perforation in a previously healthy 62‐year‐old male who presented with a six‐month history of worsening dyspnea and peripheral edema. Blood cultures, inflammatory markers, and autoimmune profile were negative. Transthoracic echocardiography demonstrated severe mitral regurgitation ( MR ) with a possible AMVL perforation, which was confirmed by three‐dimensional transesophageal echocardiography as a well‐circumscribed hole in the A2 segment. The patient made a successful recovery from mitral valve repair surgery.