Late perforation of anterior mitral leaflet after surgical resection of the subaortic membrane.

A 54-year-old woman who underwent surgical resection of the subaortic membrane 10 years earlier presented with new onset dyspnea. Cardiovascular examination revealed 3-4/6 pansystolic murmur at the apex. She was found to have severe mitral regurgitation (MR) with transthoracic echocardiography; 2D and real-time-3D transesophageal echocardiography demonstrated severe MR through anterior mitral leaflet perforation with precise localization. The patient was treated with surgery in which the perforated segment was closed by direct suture technique and discharged on postoperative 5th day. <Learning objective: Late anterior mitral leaflet perforation after surgical or interventional procedures has rarely been reported. We present this case to emphasize the role of traumatic injury to weak endothelial surfaces such as a valve leaflet in the development of late leaflet perforation after surgical or interventional procedures.>.