P836 Long-term survival of a rare case of pseudoaneurysm of the mitral-aortic intervalvular fibrosa as a complication of endocarditis of a bicuspid aortic valve

Abstract

Abstract Introduction This is a case report of a rare condition of pseudoaneurysm of the mitral-aortic intervalvular fibrosa (P-MAIVF). Case presentation The patient was a 42-year-old Filipino gentleman. He first presented to us in 2014, for routine echocardiographic examination as a part of a preoperative assessment for a non-cardiac surgery. Patient was asymptomatic and had a history of bicuspid aortic valve, which was complicated by endocarditis in 2006, and was treated with antibiotics. Echocardiography findings: Transthoracic echocardiography (TTE) showed a bicuspid aortic valve of no hemodynamic significance . A P-MAIVF was noted by Transesophageal echocardiography as a cavity expanding posteriorly into the left atrium from the left ventricular outflow tract, with a narrow neck at the junction of the aortic posterior cusp and the anterior mitral leaflet (Figure A). The cavity showed the characteristic expansion during ventricular systole, and collapse in diastole. Color flow showed the flow through the neck in systole and emptying during diastole (Figures C,D). There was mild mitral incompetence and no fistula was detected. Diagnosis was confirmed by cardiac magnetic resonance (Figure B). Follow up Because of the known complications of this condition, some of which are potentially fatal (such as rupture into the pericardium and tamponade), he was offered a surgical repair, which he had refused. Alternative conservative follow-up strategy was implemented and we had the opportunity to follow him for more than 5 years. During these years he was asymptomatic and uncomplicated. There was no change in the size of the pseudoaneurysm or its flow pattern. Conclusion This report demonstrates a rare case of P-MAIF as a complication of bicuspid aortic valve endocarditis and a long-term patient survival of a potentially fatal condition without corrective surgery. Abstract P836 Figures A,B,C,D