Pseudoaneurysm of the mitral-aortic intervalvular fibrosa on a native aortic valve following infective endocarditis

Echocardiographic Diagnosis and Outcome of Pseudoaneurysm of the Mitral-Aortic Intervalvular Fibrosa: Results of a Single-Center Experience in Beijing

Pseudoaneurysm of the mitral-aortic intervalvular fibrosa (P-MAIVF) is a rare but potentially fatal entity. Early diagnosis and surgical treatment are particularly important to decrease risk of mortality. The purpose of this study was to explore the echocardiographic characteristics and outcome of P-MAIVF and to evaluate the potential application of three-dimensional (3D) echocardiography in the evaluation of P-MAIVF. Clinical and echocardiographic characteristics were retrospectively evaluated in 9 patients with P-MAIVF, 5 of them assessed by 3D echocardiography. P-MAIVF was identified on echocardiography and located in the posterior aspect of the aortic root, expanding in systole and collapsing in diastole. Of the 9 cases examined, 8 were associated with endocarditis and 1 was caused by radio frequency catheter ablation of atrial fibrillation. Five cases were associated with bicuspid aortic valve, and rupture of P-MAIVF was identified in 3 patients. The morphology of P-MAIVF was clearly demonstrated on 3D echocardiography in 5 cases. In conclusion, echocardiography provides a useful tool in the diagnosis of P-MAIVF. Color Doppler flow imaging can ease identification of the ostium in cases of ruptured pseudoaneurysms. Three-dimensional echocardiography shows the relationship between P-MAIVF and the adjacent anatomic structures.

Pseudoaneurysm of the mitral-aortic intervalvular fibrosa. A new comprehensive review

Pseudoaneurysm of the mitral-aortic intervalvular fibrosa (P-MAIVF) is an infrequent but potentially life-threatening condition. Both transthoracic echocardiography (TTE) and transesophageal echocardiography (TEE) can detect P-MAIVF with sensitivity rates of 43 and 90 %, respectively. The typical finding of echocardiography is a pulsatile echo-free sac that expands in systole and collapses in diastole. Our review comprises 166 patients with P-MAIVF, including eight cases in our hospital and 158 cases from the literature. P-MAIVF is often associated with infection or surgical trauma. While it is likely to maintain an asymptomatic course, symptoms of shortness of breath, heart failure, valvular disease, chest pain, endocarditis, and cerebrovascular events are common clinical presentations. The recommended treatment is surgery. However, conservative therapy is an alternative approach for high-risk patients or when surgical treatment is refused. With the increasing incidence of cardiac surgery and infective endocarditis, a likely increment in the new diagnosis of pseudoaneurysm is expected.