Native Aortic Valve Endocarditis Complicated by Splenic Infarction and Giant Mitral-Aortic Intervalvular Fibrosa Pseudoaneurysm—A Case Report and Brief Review of the Literature

Andreea Varga,Maria Andrada Jiga,Cristina Maria Tatar,Ioan Tilea,Robert Adrian Dumbrava,Horatiu Suciu,Marian Pop,Dragos Gabriel Iancu

doi:10.3390/diagnostics11020251

Abstract

Background: Pseudoaneurysm of the mitral-aortic intervalvular fibrosa (P-MAIVF) is an unusual complication related to various injuries or conditions which involve the mitro-aortic region; it communicates with the left ventricular outflow tract and is associated with a high-risk of redoubtable complications or sudden death. The cerebral and splenic localizations are frequently seen as manifestations of systemic embolism in infective endocarditis. Currently, there are no specific recommendations related to the diagnosis, management, treatment, or further evolution of patients with P-MAIVF and concomitant splenic infarction. This paper presents the case of a 43-year-old Caucasian woman with a late diagnosis of mixed bicuspid aortic valve disease, affected by an under-detected and undertreated episode of infective endocarditis leading to asymptomatic P-MAIVF. Prime clinical and imagistic diagnosis of splenic infarction indicated further extended investigations were required to clarify the source of embolism. Methods: Integrated multimodality imaging techniques confirmed the unexpected diagnosis of P-MAIVF. Results: The case had a fatal outcome following an uncomplicated yet laborious cardiac surgery. Patient death was attributed to a malignant ventricular arrhythmia. Conclusion: The present case raises awareness by highlighting an unexplained and unexpected splenic infarction association with P-MAIVF as a result of infective endocarditis related to mixed bicuspid aortic valve disease.

Highlights

The mitral-aortic intervalvular fibrosa (MAIVF) is an avascular frail fibrous structure that delineates the anterior mitral leaflet from the posterior portion of the aortic root
We report a large Pseudoaneurysm of the mitral-aortic intervalvular fibrosa (P-MAIVF) complicated with Splenic infarcts (SI) and abscess in a middle-aged Caucasian woman with negative blood cultures infective endocarditis affecting the bicuspid aortic valve
We diagnosed a pseudoaneurysm of the mitral-aortic intervalvular fibrosa, culturenegative endocarditis, severe aortic stenosis, moderate aortic and mitral regurgitation, heart failure with preserved ejection fraction NYHA functional class III, splenic infarction, iron deficiency anemia, and thrombocytopenia

Summary

Introduction

The mitral-aortic intervalvular fibrosa (MAIVF) is an avascular frail fibrous structure that delineates the anterior mitral leaflet from the posterior portion of the aortic root. It is bounded by the pericardium in the upper part, and the left atrium in the posterolateral part; the left ventricular outflow tract (LVOT) represents the lower limit of the MAIVF [1,2]. Perforation secondary to infection of the mitral-aortic intervalvular fibrosa can lead to the development of P-MAIVF, in patients with a bicuspid aortic valve, due to congenital weakness of this area, as described by Qizilbash et al [7]. We report a large P-MAIVF complicated with SI and abscess in a middle-aged Caucasian woman with negative blood cultures infective endocarditis affecting the bicuspid aortic valve

Case Presentation

Findings

Discussion

Conclusions