Pseudoaneurysm Of Mitral-aortic Intervalvular Fibrosa Research Articles

Pseudoaneurysm of mitral-aortic intervalvular fibrosa with rupture: a case report

BackgroundMitral-aortic intervalvular fibrosa (MAIVF) is a fibrous region connecting the anterior mitral leaflet (AML) and aortic valve. Pseudoaneurysm of the MAIVF is a rare condition that has been reported as a sequela of infective endocarditis (IE) and surgical trauma. Here, we report a case of a ruptured pseudoaneurysm of the MAIVF, along with some literature reviews.Case presentationA 65-year-old man diagnosed with moderate aortic regurgitation five years previously had a fever of unknown origin. He suddenly developed headache and apraxia and was transported to our hospital. He was diagnosed with intracranial hemorrhage and admitted. One week after admission, echocardiography revealed aorto-mitral discontinuity and protrusion with severe regurgitant flow from left ventricular outflow tract to the left atrium. The AML was suspected to have ruptured. However, intraoperatively, the AML structure was preserved. A ruptured pseudoaneurysm of the MAIVF was also observed. Therefore, we successfully performed pseudoaneurysm repair using a bovine pericardial patch, aortic valve replacement, and mitral annuloplasty.ConclusionsP-MAIVF is a rare but potentially life-threatening complication of IE, for which timely diagnosis and prompt appropriate therapeutic intervention are required. In the present case, although neither obvious active IE nor history of previous IE could be identified, healed IE was considered based on the clinical course. The patient had intracranial hemorrhage (ICH) with well-controlled heart failure and underwent elective surgical repair more than one month after the onset of ICH, while the clinical course after the surgical procedure was uneventful.

Severe Anemia in a Case with Chronic Kidney Disease and Mechanical Heart Valve

Introduction: Infective endocarditis is a serious disease with high morbidity and mortality, especially when associated with renal failure. Anemia is a common finding in chronic kidney disease. Here, we present a case of renal failure and severe anemia with a complicated mechanical heart valve infection with a Delayed diagnosis. Case Presentation: A 68-year-old male patient with a history of chronic kidney disease and metallic aortic valve surgery presented with fever, severe anemia, and about 10-kg weight loss that eventually revealed infective endocarditis in echocardiography with significant valvular leakage, pseudoaneurysm of mitral-aortic intervalvular fibrosa and a fistula to left ventricular outflow tract and sinus Valsalva of the aorta. Conclusions: This case report indicates that anemia, renal failure, and fever of unknown origin can be one of the diagnostic signs of endocarditis. It is important to consider infectious endocarditis in high-risk patients because late diagnosis greatly increases mortality, serious complications, and morbidity.

Repeat aortic valve replacement (AVR) for pseudoaneurysm of mitral-aortic intervalvular fibrosa (P-MAIVF) repair due to hemolytic anemia 6 years after AVR: a case report

BackgroundPseudoaneurysm of the mitral-aortic intervalvular fibrosa (P-MAIVF) after infective endocarditis and/or valve replacement is rarely reported, and transesophageal echocardiography and cardiac multidetector computed tomography are useful for diagnosis. Surgery is mostly recommended to prevent fatal complications.Case presentationA 61-year-old man underwent repeat aortic valve replacement (AVR) with repair of a P-MAIVF due to hemolytic anemia 6 years after AVR, and 4 months after treatment of sepsis and an infected abdominal aortic aneurysm. Two years after the surgery, the patient is alive and well with no recurrence.ConclusionsThe present case was considered to be a very rare case in which surgery was performed because the blood flow entering and leaving the P-MAIVF contacted the prosthetic valve ring, resulting in hemolysis, severe anemia, and heart failure.

Pseudoaneurysm of Mitral-Aortic Intervalvular Fibrosa – A Case Report

Pseudoaneurysm of mitral-aortic intervalvular fibrosa (P-MAIVF) is a rare, well-known entity with few cases reported in the literature. We here present a case report of repair of large P-MAIVF that was successfully managed. Postoperatively patient had an uneventful course and patient was asymptomatic at 3rd month follow-up. The cause of P-MAIVF could be an atheromatous ulcer at interleaflet trigone with severely calcified aortic valve as in our case. Even if the imaging and diagnostic modalities are inconclusive, a strong suspicion should be made preoperatively in the presence of abovementioned combination for better preparedness to improve the outcome of surgery.

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

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.

Pseudoaneurysm of the Mitral-Aortic Fibrosa in the Absence of Valvulitis.

The mitral-aortic intervalvular fibrosa (MAIVF) is the thin avascular fibrous structure located between the left side of the non-coronary cusp, the left coronary cusp and the anterior mitral leaflet. MAIVF pseudoaneurysm typically results as a complication of endocarditis, aortic valve surgery or chest trauma. We present a case of an incidental MAIF pseudoaneurysm in a 68-year female with a history of rheumatic fever without involvement of the mitral apparatus. We also discuss the presentation, evaluation and management of this rather rare valvular disorder.

P1716 Aorto-left atrial fistula with left atrium dissection

Abstract We report a 71 year-old female with a history of rheumatic valvulopathy, who underwent St. Jude 23 and St. Jude 21 in mitral and aortic position replacement. The patient was admitted to the ER for pulmonary edema with haemoglobin level of 7.7 g/dL .No evidence of gastrointestinal bleeding. She was assessed to exclude intravascular hemolysis: bilirrubin 3.1mg/d,L direct bilirrubin 1.0 mg/dL, reticulocytes 207.000/mcL 6.8%, LDH 1.213, free plasmatic haemoglobin 9.6mg/dL, haptoglobin < 1 mg/dL, negative direct and indirect Coombs. Upon suspicion of hemolytic anemia in relation to prosthetic dysfunction, TEE was performed revealing stenotic mechanical aortic prosthesis with abundant pannus and normofunctional mitral prosthesis, no leakages were observed. A coronary CT scan showed severe calcification of the aortic root and mitral annulus without evidence of redundant tissue than hindered the opening of the aortic or mitral valves. Cardiac catheterization revealed normal coronary arteries, cardiac output preserved and mild passive predominance of PAP. Heart Team decided on aortic prosthesis valve replacement. On March 22, 2019 surgery was performed. There was a heavily calcified ascending aorta and aortic root with abundant pannus at the ventricular aspect of the aortic prosthesis. Former aortic prosthesis was resected and the root reconstructed with a pericardial patch. 18-mmATS mechanical aortic prosthesis was implanted. After 127minutes of cross-clamping time, the patient was admitted to the ICU. She presented a torpid course in the postoperative period after cardiac surgery and cardiogenic shock ensued. TEE was repeated, showing pseudoaneurysm of the mitral–aortic intervalvular fibrosa, left atrium dissection and severe paraprosthetic aortic leakage. Coronary CT scan revealed a large cavity, 7x4x3.5 cm, extending posteriorly and displacing cranially the right pulmonary artery and subsequently rejecting the cavity of left atrium; with final diagnosis of aorto-left atrial fistula with left atrium dissection. Emergent surgery was decided. During the procedure, mitral–aortic intervalvular fibrosa pseudoaneurysm was confirmed, perforation from the subaortic left ventricle into the left atrium was also appreciated at the junction of the aortic root pericardial patch with the dissected left atrium wall. Surgery was complicated with hemorrhagic shock and massive uncontrolled bleeding with severe coagulopathy and thrombocytopenia. The patient went into cardiac arrest and passed away in the operating room. Conclusion Aorto atrial fistulas are rare but important complications of many disease processes of the aorta and aortic valve. Classical clinical signs of continuous murmurs may not be present and echocardiography forms the cornerstone of diagnosis. AAF should be suspected in patients with poorly controlled heart failure and prior aortic surgery. Prompt surgical repair is usually helpful in relieving symptoms and decreasing mortality. Abstract P1716 Figure. Aortoatrial fistula

Concurrent congenital pseudoaneurysm of mitral-aortic intervalvular fibrosa and left sinus of Valsalva aneurysm

Either the pseudoaneurysm of mitral-aortic intervalvular fibrosa or the aneurysms of Valsalva are rare cardiac conditions. Concomitant diagnosis in the same patient is extremely rare with only one case report. Herein, we described an extremely rare case of concomitant pseudoaneurysm of mitral-aortic intervalvular fibrosa and aneurysm of left sinus of Valsalva in 21-year-old black man admitted with new-onset of heart failure (NYHA class III) diagnosed by transesophageal echocardiography. Despite medical therapy optimization for heart failure, the patient died waiting for cardiac surgery. Regarding the case, we discussed possible etiology, clinical presentation and the role of echocardiography in the diagnosis and surgical approach of this very rare association.

Pseudoaneurysm of Mitral-Aortic Intervalvular Fibrosa Following Regurgitation of Congenital Bicuspid Aortic Valve in a 63-year-Old Patient: A Case Report

Pseudoaneurysm of mitral aortic intervalvular fibrosa (P-MAIVF) is a rare but potentially catastrophic condition. P-MAIVF is often associated with infective endocarditis, aortic valve surgery or chest trauma. However, P-MAIVF attributed to congenital abnormality is even rarer. Here, we present a case of chronic, non-infective P-MAIVF associated with congenital bicuspid aortic valve. In the present case, there is neither a history nor sign suggesting infective endocarditis, nor positive blood or tissue culture results. The preoperative Transesophageal echocardiography (TEE) examination detected P-MAIVF with severe regurgitation of bicuspid aortic valve, which was misdiagnosed as pure bicuspid aortic valve regurgitation by transthoracic echocardiogram (TTE). Consequently, TEE provides valuable information on the diagnosis and choice of surgery for the patient.

Congenital pseudoaneurysm of mitral-aortic intervalvular fibrosa masquerading as left atrial mass in fetal life

A 28-week-old fetus was detected to have a single left atrial mass in prenatal ultrasound. Postnatal echocardiography showed an aneurysm between the anterior mitral leaflet and aortic valve, to the left of atrioventricular junction and communicating with the left ventricle through a narrow mouth. It probably originated from the mitral-aortic intervalvular fibrous tissue and an inherent weakness at this site might be the cause. Reported cases of pseudoaneurysm of mitral-aortic intervalvular fibrosa and subvalvular ventricular aneurysms seen following infective endocarditis, surgery, or trauma seem to have a similar anatomical background. This case explains the possibility of congenital aneurysm in this location which needs to be considered a differential diagnosis in similar cases.

Large unruptured Pseudoaneurysm of Mitral-Aortic Intervalvular Fibrosa-Managed Conservatively for Three Years: Case Report and Review of Literature

Here in, we describe a rare case of an eleven years old boy who was diagnosed with infective endocarditis of a congenitally bicuspid aortic valve with severe aortic stenosis, severe aortic regurgitation and complicated by cerebral embolism. He was managed with intravenous antibiotics for 6 weeks. A pre-discharge transthoracic echocardiogram revealed a large, unruptured pseudoaneurysm of the mitral-aortic inter valvular fibrosa that was confirmed by transesophageal echocardiography and cardiac MRI. Patient’s parents initially refused surgery and he was managed conservatively for 3 years. Serial echocardiograms performed during this period demonstrated progressive dilatation of the left ventricle and aorta, with a small increase in the size of pseudoaneurysm. Patient was subsequently referred for surgery (Aortic valve replacement with reconstruction of mitralaortic intervalvular fibrosa). In conclusion, our case demonstrates that close clinical follow up and periodic imaging may be a reasonable alternative to early surgery in managing patients with uncomplicated pseudoaneurysm of mitral-aortic intervalvular fibrosa. Key words: Pseudoaneurysm, Mitral-aortic intervalvular fibrosa, Bicuspidaortic valve, Infective endocarditis.

Double cardiac pseudoaneurysm in a postoperative patient

A mitral-aortic intervalvular fibrosa pseudoaneurysm is a rare complication after aortic and mitral valve replacement and aortic root replacement. A left ventricular pseudoaneurysm after mitral valve replacement is also a rare complication. Here, we describe a 48-year-old woman with a history of a Bentall operation and mitral valve replacement 6 years before, presenting with double pseudoaneurysms in the left ventricle and mitral-aortic intervalvular fibrosa, detected via transesophageal echocardiography.

Pseudoaneurysm of mitral-aortic intervalvular fibrosa after aortic valve replacement

A 16-year-old female patient in whom a biologic aortic valve was implanted for bicuspid aortic valve, aortic stenosis with aortic regurgitation one year ago and discharged uneventfully was re-admitted to our clinic with dyspnea on exertion and fatigue. Transthoracic echocardiography revealed valvular aortic stenosis (a peak pressure gradient of 48 mmHg), second degree aortic regurgitation and sinus valsalva aneurysm. Multislice computed tomography angiography produced an image which was associated with sinus valsalva aneurysm at the subvalvular level or a pseudoaneurysm. She underwent mechanical aortic valve replacement and reconstruction of both valvular and subvalvular areas with a Dacron patch. After an uneventful recovery stay in the intensive care unit, the patient was discharged in the sixth postoperative day. This case highlights the development of a mitral-aortic intervalvular fibrosa pseudoaneurysm as a rare complication of aortic valve replacement.

Detection of multiple pseudoaneurysms of mitral-aortic intervalvular fibrosa by multislice computed tomography in a patient with aortic valve replacement

Mitral-aortic intervalvular fibrosa pseudoaneurysms are a rare entity that may complicate mitral valve surgery and the management of infective endocarditis and thoracic trauma. They may result in fistulisation, valve dysfunction, pericardial rupture and mass effect to the adjacent organs. Here we present a patient of aortic insufficiency with aortic valve replacement and multiple pseudoaneurysms, detected by 64 slices CT.

Native Aortic Valve Endocarditis Complicated by Pseudoaneurysm of Mitral-Aortic Intervalvular Fibrosa

Pseudoaneurysm of mitral-aortic intervalvular fibrosa (PA-MAIVF) is a rare complication of native aortic valve endocarditis. This region is a relatively avascular area and prone to infection during endocarditis and subsequent aneurysm formation. The rupture into the pericardial cavity and left atrium or aorta, systemic embolism, myocardial infarction secondary to left coronary compression, and sudden death are the reported complications. Herein, we present a 9-year-old boy who was diagnosed with bicuspid aortic valve endocarditis complicated by PA-MAIVF, cerebral embolism, and hemorrhage. PA-MAIVF was visualized by both two- and three-dimensional transthoracic echocardiography and ruptured into pericardial space causing a fatal outcome.

Transesophageal echocardiography in surgical management of pseudoaneurysm of mitral-aortic intervalvular fibrosa with aneurysms of right sinus of Valsalva and left main coronary artery

Pseudoaneurysm of mitral-aortic intervalvular fibrosa (MAIVF) is a rare complication associated with aortic and/or mitral valve surgery complicated by infective endocarditis. We report pseudoaneurysm of MAIVF in a young adult without overt cardiac disease or previous cardiac surgery. The patient had a rare combination of pseudoaneurysm of MAIVF impinging on anterior mitral leaflet causing moderate mitral regurgitation, right sinus of Valsalva aneurysm extending into interventricular septum, and left main coronary artery aneurysm. Transesophageal echocardiography helped in confirming the lesions, delineating the anatomy of all the lesions, and assessing the adequacy of surgical repair.

Pseudoaneurysm of the mitral–aortic intervalvular fibrosa presenting after chest trauma and diagnosed by cardiac magnetic resonance: a case report

IntroductionAnnular subvalvular pseudoaneurysm is a rare example of left ventricle aneurysm described predominantly in young African people. These aneurysms are divided into two different types, namely, submitral or subaortic, with subaortic being the less frequent kind. The subaortic type is most often localized in the mitral–aortic intervalvular fibrosa. To the best of our knowledge, this is the first report of a mitral–aortic intervalvular fibrosa pseudoaneurysm associated with coarctation of the aorta, anomalous pulmonary venous return, bicuspid aortic valve and patent ductus arteriosus diagnosed by cardiovascular magnetic resonance.Case presentationWe report the case of a 15-year-old African-American boy with a history of mild chest trauma who underwent echocardiographic evaluation as part of an out-patient work up. The echocardiogram was suspicious for the presence of mitral-aortic intervalvular fibrosa pseudoaneurysm and cardiovascular magnetic resonance was then performed to better characterize this finding. In addition to confirming the presence of the aneurysm, cardiovascular magnetic resonance also revealed coarctation of the aorta, a bicuspid aortic valve, and anomalous pulmonary venous return.ConclusionIn our case, cardiovascular magnetic resonance was helpful in: (a) making a definite diagnosis of mitral–aortic intervalvular fibrosa pseudoaneurysm and its borders, which was not clear with an echocardiogram examination; and (b) illustrating additional associated congenital anomalies including the anomalous pulmonary venous return.

Subacute Staphylococcus epidermidis Bacterial Endocarditis Complicated by Mitral-Aortic Intervalvular Fibrosa Pseudoaneurysm.

The patient is a 75-year-old man with a history significant for hypertension and congestive heart failure who underwent a bioprosthetic aortic valve replacement secondary to acute onset of aortic insufficiency. Cultures of the native valve were positive for Staphylococcus epidermidis sensitive to nafcillin and intravenous cefazolin was initiated. On postoperative day 24, he developed acute decompensated heart failure. A transesophageal echocardiogram demonstrated a structurally abnormal mitral valve with severe regurgitation, anterior and posterior leaflet vegetations, and scallop prolapse. There was also evidence of a mitral-aortic intervalvular fibrosa pseudoaneurysm (P-MAIF) with systolic expansion and flow within the aneurysm. Antibiotic treatment was changed from cefazolin to vancomycin for presumed development of methicillin-resistant Staphylococcus. He subsequently underwent a bioprosthetic mitral valve replacement and has restoration of health without sequella. This case highlights the development of a P-MAIF as a rare complication of both aortic or mitral valve replacement and infective endocarditis.

Pseudoaneurysms of the mitral-aortic intervalvular fibrosa: Survival without reoperation

the tissue spanning the mitral and aortic valves, the mitral-aortic intervalvular fibrosa (MAIVF), may be the site of pseudoaneurysm formation in the setting of infective endocarditis or congenital heart disease, or after valve surgery. Because of potential complications of MAIVF pseudoaneurysms, patients with such lesions are often referred for surgical repair. we identified 3 individuals with MAIVF pseudoaneurysms who were followed without surgical intervention after diagnosis of the MAIVF pseudoaneurysm. The courses of these patients are presented below. the MAIVF pseudoaneurysms were measured to be stable in size over several years among 3 patients. Dimensions were 5.3 × 2.3, 7.6 × 4.9, and 4.8 × 2.5 cm. Surgical repair was considered too high a risk in 2 of the individuals, and the third individual refused a third surgical intervention. Of the 3 patients, 2 remain asymptomatic. The third patient was 87 years old when her MAIVF pseudoaneurysm was diagnosed, and she died of noncardiac causes at age 92 years. clinical surveillance and serial imaging of MIAVF pseudoaneurysms may be considered an alternative to surgical management in select individuals.

A case of echocardiographic evaluation of ruptured pseudoaneurysm of the mitral-aortic intervalvular fibrosa by infective endocarditis.

This report describes an unusual case of ruptured pseudoaneurysm (PSA) of mitral-aortic intervalvular fibrosa (MAIVF) caused by infective endocarditis. The PSA ruptured into the left sinus of Valsalva in addition to the left atrium, resulting in complicated shunting among the aorta, left ventricle and left atrium, leading to refractory heart failure. The transesophageal echocardiography provided the precise information concerning the anatomical detail of the PSA, which is crucial for the surgical repair. This is the first report describing a patient with PSA of MAIVF with two rupture sites.