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Mirhosseini SM, Soltanipur M, Yarmohammadi H, Rezaei M, Fattah E, Bayat F. Thirty-three-year follow-up of pseudoaneurysm of the mitral-aortic intervalvular fibrosa without surgical treatment: a case report and literature review. J Cardiothorac Surg 2024; 19:345. [PMID: 38907323 PMCID: PMC11191241 DOI: 10.1186/s13019-024-02885-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2024] [Accepted: 06/15/2024] [Indexed: 06/23/2024] Open
Abstract
BACKGROUND Pseudoaneurysm of the mitral-aortic intervalvular fibrosa (PMAIF) is a rare complication of infective endocarditis or aortic valve surgery. Surgical treatment is suggested, but the long-term follow-up of conservative management remains unclear. CASE PRESENTATION A 33-year follow-up of a patient who developed PMAIF six years after aortic valve replacement is reported. The patient presented to our center with dyspnea, and the echocardiography revealed an ejection fraction of 20% and a PMAIF measuring 7 × 10 mm. Despite being advised to undergo surgery, the patient declined due to fear of surgical outcomes. Consequently, conservative treatment with close observation but without surgery was initiated. During the 33-year follow-up period, the patient did not experience any adverse health effects. CONCLUSION Surgical intervention should be considered whenever the PMAIF is diagnosed. However, in any case that the surgery was not applicable, conservative management might lead to long-term survival, based on this and similar case reports in the literature.
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Affiliation(s)
| | - Masood Soltanipur
- Cardiovascular Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Quality of Life Department, Breast Cancer Research Center, Motamed Cancer Institute, ACECR, Tehran, Iran
- Department of Mycobacteriology and Pulmonary Research, Pasteur Institute of Iran, Tehran, Iran
| | - Hossein Yarmohammadi
- Cardiovascular Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mahdi Rezaei
- Cardiovascular Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Department of Mycobacteriology and Pulmonary Research, Pasteur Institute of Iran, Tehran, Iran
| | - Eisa Fattah
- School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Fariba Bayat
- Cardiovascular Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
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Figueroa-Casanova R, Saavedra-Henao JD, Figueroa-Laverde JS, Beltrán-Gonzales DA, Labrador-Rosales JG, Eslait-Olaciregui S, Pérez Rivera CJ. Fistula of the mitral-aortic intervalvular fibrosa in a patient with bacterial endocarditis: a case report and systematic literature review. J Cardiothorac Surg 2024; 19:300. [PMID: 38807242 PMCID: PMC11131286 DOI: 10.1186/s13019-024-02736-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Accepted: 03/29/2024] [Indexed: 05/30/2024] Open
Abstract
BACKGROUND A fistulous tract in the mitro-aortic intervalvular fibrosa (MAIVF) is a rare entity, which presents as a complication of endocarditis or surgical trauma. Generally, it is associated to a pseudoaneurysm of the MAIVF (p-MAIVF) or aortic abscesses. MAIVF fistulas could potentially lead to devastating complications and a high mortality rate. This condition is managed surgically, either by a percutaneous closure or an open surgical approach. Herein we report the complex case of a patient with a MAIVF fistula secondary to bacterial endocarditis. Further clinical deterioration was caused by severe aortic valve insufficiency and hemodynamic compromise, requiring surgical intervention. CASE PRESENTATION A 74-year-old male patient was admitted to a primary care center with complaints of malaise, asthenia, adynamia, hyporexia, and lower limb edema over the past eight days. His past medical history is positive for arterial hypertension and being monorenal. A transesophageal echocardiogram (TEE) was performed, exhibiting a 56% left ventricle ejection fraction (LVEF) and complicated aortic valve endocarditis. Surgical management through an open approach included vegetation resection, valve replacement, and closure of the MAIVF fistula. After completing antibiotic therapy, the patient was discharged without complications. During postoperative follow-up, the patient remained asymptomatic, and the control echocardiogram showed no signs of MAIVF fistula.4. CONCLUSIONS The clinical case of a patient with a MAIVF fistula secondary to endocarditis by Streptococcus Anginous was presented. The fistulous tract was not associated to p-MAIVF or aortic abscess, findings which further deteriorate the patient's condition and increase the likelihood of fatality. This case reinforces the importance of a prompt diagnosis through cardiac imaging and timely surgical closure of the defect.
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Nakata K, Moriyama S, Takaki J, Takeo M, Doi H, Matsumura T, Fukui T. Pseudoaneurysm of mitral-aortic intervalvular fibrosa with rupture: a case report. Surg Case Rep 2023; 9:210. [PMID: 38044395 PMCID: PMC10694109 DOI: 10.1186/s40792-023-01789-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Accepted: 11/26/2023] [Indexed: 12/05/2023] Open
Abstract
BACKGROUND Mitral-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 PRESENTATION A 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. CONCLUSIONS P-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.
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Affiliation(s)
- Kosuke Nakata
- Department of Cardiovascular Surgery, Kumamoto Rosai Hospital, 1670 Takehara-Machi, Yatsushiro, Kumamoto, 866-8533, Japan.
- Department of Cardiovascular Surgery, Kumamoto University Hospital, Kumamoto, Japan.
| | - Shuji Moriyama
- Department of Cardiovascular Surgery, Kumamoto Rosai Hospital, 1670 Takehara-Machi, Yatsushiro, Kumamoto, 866-8533, Japan
| | - Jun Takaki
- Department of Cardiovascular Surgery, Kumamoto University Hospital, Kumamoto, Japan
| | - Masahiro Takeo
- Department of Cardiology, Kumamoto Rosai Hospital, Yatsushiro, Kumamoto, Japan
| | - Hideki Doi
- Department of Cardiology, Kumamoto Rosai Hospital, Yatsushiro, Kumamoto, Japan
| | - Toshiyuki Matsumura
- Department of Cardiology, Kumamoto Rosai Hospital, Yatsushiro, Kumamoto, Japan
| | - Toshihiro Fukui
- Department of Cardiovascular Surgery, Kumamoto University Hospital, Kumamoto, Japan
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Xie D, Jiang L, Zhang J, Li X, Guo Y. Pseudoaneurysm of the mitral-aortic intervalvular fibrosa: a rare case after percutaneous transluminal coronary angioplasty. BMC Cardiovasc Disord 2023; 23:477. [PMID: 37752428 PMCID: PMC10521427 DOI: 10.1186/s12872-023-03512-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2023] [Accepted: 09/15/2023] [Indexed: 09/28/2023] Open
Abstract
BACKGROUND Pseudoaneurysm of the mitral-aortic intervalvular fibrosa (P-MAIVF) is an uncommon but potentially life-threatening condition. The most common pathogenic factors of P-MAIVF are infective endocarditis and surgical valve operation. Here, we report a rare case of P-MAIVF which occurred one year after percutaneous transluminal coronary angioplasty (PTCA). CASE PRESENTATION A 31-year-old man developed a P-MAIVF one year after PTCA. Transthoracic echocardiography (TTE) revealed a pseudoaneurysm between the aortic root and the left atrium. Three-dimensional transesophageal echocardiography (3D-TEE) clearly demonstrated the orifice of the pseudoaneurysm. This case was initially diagnosed by ultrasound, and the prognosis was good after surgical repair. CONCLUSIONS We report a rare case of P-MAIVF that occurred one year after PTCA.
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Affiliation(s)
- Debo Xie
- Department of Ultrasound, Southwest Hospital, Army Medical University (Third Military Medical University), Chongqing, 400038, China
| | - Lulu Jiang
- Department of Ultrasound, Southwest Hospital, Army Medical University (Third Military Medical University), Chongqing, 400038, China
| | - Jun Zhang
- Department of Ultrasound, Southwest Hospital, Army Medical University (Third Military Medical University), Chongqing, 400038, China
| | - Xin Li
- Department of Ultrasound, Southwest Hospital, Army Medical University (Third Military Medical University), Chongqing, 400038, China
| | - Yanli Guo
- Department of Ultrasound, Southwest Hospital, Army Medical University (Third Military Medical University), Chongqing, 400038, China.
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Saadia S, Sultan FAT, Iqbal S, Fatimi SH, Nasir A. Case report: Aorto-left atrial fistula-A rare complication of native aortic valve endocarditis. Egypt Heart J 2023; 75:58. [PMID: 37432517 DOI: 10.1186/s43044-023-00384-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Accepted: 06/23/2023] [Indexed: 07/12/2023] Open
Abstract
BACKGROUND Aorto-cavitary fistula is a rare complication of infective endocarditis. Multimodal imaging is commonly required to assess the severity and extent of infection because of the complex pathology of the valvular and paravalvular apparatus in endocarditis. CASE PRESENTATION We present an unusual case of a middle-aged man with recent history of meningoencephalitis who developed infective endocarditis complicated by ruptured abscess in inter-valvular fibrosa between aortic and mitral valve resulting in free communication or fistula formation between aorta and left atrium. Patient underwent double valve replacement (aortic and mitral) along with repair of the aorta. CONCLUSIONS Our case highlights recognition of this rare clinical presentation of aorto-left atrial fistula in infective endocarditis and the diagnostic role of transesophageal echocardiography in good clinical outcome with aggressive and timely management.
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Affiliation(s)
- Sheema Saadia
- Section of Cardiology, Department of Medicine, The Aga Khan University Hospital, Karachi, Pakistan
| | - Fateh Ali Tipoo Sultan
- Section of Cardiology, Department of Medicine, The Aga Khan University Hospital, Karachi, Pakistan.
| | - Sara Iqbal
- Section of Cardiothoracic Surgery, Department of Surgery, The Aga Khan University Hospital, Karachi, Pakistan
| | - Saulat Hasnain Fatimi
- Section of Cardiothoracic Surgery, Department of Surgery, The Aga Khan University Hospital, Karachi, Pakistan
| | - Aiysha Nasir
- Section of Cardiology, Department of Medicine, The Aga Khan University Hospital, Karachi, Pakistan
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Romiti S, Wretschko E, Saltarocchi S, D'Abramo M, Orchi PD, Bruno N, Vinciguerra M, Totaro M, Miraldi F, Greco E. Incidental pseudoaneurysm of the mitral-aortic intervalvular fibrosa in asymptomatic patient: A case report. J Card Surg 2022; 37:5603-5607. [PMID: 36378834 DOI: 10.1111/jocs.17202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Accepted: 10/27/2022] [Indexed: 11/16/2022]
Abstract
Pseudoaneurysm of the mitral-aortic intervalvular fibrosa (P-MAIVF) can be a rare but life-threatening complication of infective endocarditis, cardiac surgery, or blunt chest trauma. Congenital heart diseases especially in young patients are reported as additionally predisposing factors. We present the case of an asymptomatic 52 years-old male with bicuspid aortic valve and gastrointestinal polyposis syndrome in whom a P-MAIVF was incidentally detected. The patient successfully underwent pseudoaneurysm surgical repair and aortic valve replacement and despite no evident causes were found we hypothesized addiotional underlying mechanism of P-MAIVF.
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Affiliation(s)
- Silvia Romiti
- Department of Clinical, Internal Medicine, Anaesthesiology and Cardiovascular Sciences, Sapienza University of Rome, Rome, Italy
| | - Eleonora Wretschko
- Department of Clinical, Internal Medicine, Anaesthesiology and Cardiovascular Sciences, Sapienza University of Rome, Rome, Italy
| | - Sara Saltarocchi
- Department of Clinical, Internal Medicine, Anaesthesiology and Cardiovascular Sciences, Sapienza University of Rome, Rome, Italy
| | - Mizar D'Abramo
- Department of Clinical, Internal Medicine, Anaesthesiology and Cardiovascular Sciences, Sapienza University of Rome, Rome, Italy
| | - Paolo De Orchi
- Department of Clinical, Internal Medicine, Anaesthesiology and Cardiovascular Sciences, Sapienza University of Rome, Rome, Italy
| | - Noemi Bruno
- Department of Clinical, Internal Medicine, Anaesthesiology and Cardiovascular Sciences, Sapienza University of Rome, Rome, Italy
| | - Mattia Vinciguerra
- Department of Clinical, Internal Medicine, Anaesthesiology and Cardiovascular Sciences, Sapienza University of Rome, Rome, Italy
| | - Marco Totaro
- Department of Clinical, Internal Medicine, Anaesthesiology and Cardiovascular Sciences, Sapienza University of Rome, Rome, Italy
| | - Fabio Miraldi
- Department of Clinical, Internal Medicine, Anaesthesiology and Cardiovascular Sciences, Sapienza University of Rome, Rome, Italy
| | - Ernesto Greco
- Department of Clinical, Internal Medicine, Anaesthesiology and Cardiovascular Sciences, Sapienza University of Rome, Rome, Italy
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Ku L, Lv H, Ma X. An abscess of mitral aortic intervalvular fibrosa mimicking an intracardiac mass. J Card Surg 2022; 37:2138-2141. [PMID: 35397124 DOI: 10.1111/jocs.16507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Revised: 03/14/2022] [Accepted: 03/16/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND Abscess of the mitral-aortic intervalvular fibrosa (MAIVF) is a rare occurrence, with its most frequently described causative associations being active or prior endocarditis, prosthetic valves, or native valves with anomalies. We report a case of infective endocarditis (IE) complicated by an abscess of the MAIVF without valvular involvement. This case highlights the importance of this rare clinical entity and of the multimodality imaging approach in reaching an accurate diagnosis and differential diagnosis. METHODS AND RESULTS A 35-year-old male presented with fatigue and intermittent high-grade fever for a 2-week duration. IE was suspected based on a clinical exam. Transthoracic echocardiography (TTE) demonstrated heterogeneous mass with a size of about 2.9 cm × 2.3 cm coming from the MAIVF, mimicking an intracardiac mass. Color Doppler flow Imaging showed the mass without communication with the surrounding cardiovascular cavities. Cardiac computed tomography angiography (CCTA) revealed a large low-density mass without any enhancement, which was situated adjacent to the left ventricular tract with a severely compressed left atrial chamber. The patient underwent cardiac mass removal under extracorporeal circulation. During the procedure, a large abscess was found to be located in MAIVF. The postoperative course was uneventful. DISCUSSION The abscess of MAIVF is a rare entity with a high risk of developing the pseudoaneurysm of MAIVF (p-MAIVF). The periaortic spread of the abscess is a dynamic process in which the inflammation of the deep tissue causes, in the first stage, a MAIVF thickening, which eventually progresses with the formation of an abscess, and subsequently, a pseudoaneurysm. Complications of p-MAIVF include rupture into the left atrium, aorta, or pericardial space leading to hemopericardium, tamponade, and death. The major differential diagnosis for abscess of MAIVF includes p-MAIVF an intracardiac mass. TTE plays a key role in the diagnosis and differential diagnosis of abscesses of MAIVF. CCTA can be a useful adjunct to further characterize abscess spread, three-dimensional spatial relationships with other cardiac structures for preoperative planning, as well as in the evaluation of potential complications such as coronary artery compromise and communication with the aorta, left atrium, or pericardial space. Surgical management is recommended in complicated, symptomatic patients to prevent further expansion of abscesses or pseudoaneurysms. CONCLUSION The abscess of MAIVF is a rare complication of endocarditis and surgical trauma in the MAIVF area, TTE remains a first-line imaging modality for clinically suspected periaortic abscess or other IE complications. CCTA has a complementary role to echocardiography in identification, characterization, and preoperative planning.
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Affiliation(s)
- Leizhi Ku
- Department of Radiology, Wuhan Asia Heart Hospital, Wuhan, China
| | - Hang Lv
- Department of Cardiac Function, Wuhan Asia General Hospital, Wuhan, China
| | - Xiaojing Ma
- Department of Echocardiography, Wuhan Asia Heart Hospital, Wuhan, China
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Milbury K, O'Reilly C, Roberge E, Liesemer K. A case of pseudoaneurysm of the mitral-aortic intervalvular fibrosa in a pediatric patient. Radiol Case Rep 2021; 17:68-71. [PMID: 34765063 PMCID: PMC8571483 DOI: 10.1016/j.radcr.2021.09.060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Revised: 09/24/2021] [Accepted: 09/28/2021] [Indexed: 11/25/2022] Open
Abstract
Pseudoaneurysm of the mitral-aortic intervalvular fibrosa is a rare and potentially deadly aberrance of the cardiac architecture, with few reported pediatric cases. Complications can include rupture into the pericardium, ongoing infective endocarditis, arrhythmias, valvular dysfunction, thrombus formation, and compression of the coronary arteries. Although there have been cases which have gone solely with surveillance, the majority of these cases will have surgical intervention to reduce the risk of complications. We present a case in a pediatric patient with a history of bicuspid aortic valve, who presented with recurrent fevers after a dental procedure despite treatment with antibiotics. Infective endocarditis was suspected based on clinical exam, and imaging revealed pseudoaneurysm of the mitral-aortic intervalvular fibrosa. The patient was treated with surgical resection and homograft replacement.
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Affiliation(s)
- Katherine Milbury
- Department of Pediatrics, Madigan Army Medical Center, 9040 Jackson Ave, Tacoma, WA, 98431, USA
| | - Corey O'Reilly
- Department of Radiology, Madigan Army Medical Center, 9040 Jackson Ave, Tacoma, WA, 98431, USA
| | - Eric Roberge
- Department of Radiology, Madigan Army Medical Center, 9040 Jackson Ave, Tacoma, WA, 98431, USA
| | - Kirk Liesemer
- Department of Pediatrics, Madigan Army Medical Center, 9040 Jackson Ave, Tacoma, WA, 98431, USA
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Mikami T, Yoshioka D, Kawamura T, Toda K, Sawa Y, Miyagawa S. Active infective endocarditis of a bicuspid aortic valve causing left ventricular outflow tract pseudoaneurysm and right atrium shunt: A case report. Int J Surg Case Rep 2021; 88:106527. [PMID: 34688076 PMCID: PMC8536531 DOI: 10.1016/j.ijscr.2021.106527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Revised: 10/15/2021] [Accepted: 10/15/2021] [Indexed: 11/27/2022] Open
Abstract
Introduction and importance Left ventricular outflow tract pseudoaneurysm associated with infective endocarditis is a rare but life-threatening condition. Case presentation A 68-year-old man developed infective endocarditis of a bicuspid aortic valve with suspected annulus abscess and was transferred to our department for further treatment. Cardiac workup revealed the formation of a left ventricular outflow tract pseudoaneurysm penetrating the right atrium. We successfully treated the patient with pseudoaneurysm repair using a bovine pericardium patch in combination with aortic valve replacement. The patient was uneventfully discharged after 6-week antibiotic therapy and remained well for the following 2 years. Clinical discussion Surgery is the recommended treatment for left ventricular outflow tract pseudoaneurysms. Accurate diagnosis and identification of the anatomical conditions are crucial for determining the appropriate treatment. Conclusion When considering the appropriate surgical treatment for left ventricular outflow tract pseudoaneurysm associated with infective endocarditis, pseudoaneurysm repair using a bovine pericardial patch and concomitant aortic valve replacement can be an effective and feasible therapeutic option. Infective endocarditis can cause left ventricular outflow tract pseudoaneurysms. Surgery is recommended for left ventricular outflow tract pseudoaneurysms. Accurate anatomical diagnosis is crucial for determining the appropriate treatment.
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Affiliation(s)
- Tsubasa Mikami
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, Suita, Osaka, Japan.
| | - Daisuke Yoshioka
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Takuji Kawamura
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, Suita, Osaka, Japan.
| | - Koichi Toda
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Yoshiki Sawa
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, Suita, Osaka, Japan.
| | - Shigeru Miyagawa
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
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Kiryu K, Yamaura G, Igarashi I, Kadohama T, Tanaka F, Takagi D, Itagaki Y, Arai T, Wada T, Yamamoto H. Surgical treatment for accidentally discovered pseudoaneurysm of the mitral-aortic intervalvular fibrosa with bicuspid aortic valve, ascending aortic aneurysm, and myocardial ischemia: a case report. THE CARDIOTHORACIC SURGEON 2021. [DOI: 10.1186/s43057-021-00049-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Pseudoaneurysm of the mitral-aortic intervalvular fibrosa (P-MAIVF) is a rare complication of infective endocarditis and aortic valve replacement. Ruptured P-MAIVF and angina due to compression of the coronary arteries are severe complications of this condition.
Case presentation
We report a case of P-MAIVF that was diagnosed accidentally during a routine checkup. The patient was asymptomatic; however, she had a systolic murmur. She had a history of infective endocarditis, which was treated conservatively without open-heart surgery. In addition, she was diagnosed with aortic valve stenosis, aortic valve regurgitation, bicuspid aortic valve, right coronary artery stenosis, and an ascending aortic aneurysm. She was treated with surgery, which involved patch closure of P-MAIVF with aortic valve replacement, coronary artery bypass grafting, and ascending aorta replacement. After the operation, echocardiography showed no leakage from the P-MAIVF.
Conclusions
It is necessary to have knowledge of P-MAIVF. Following up cases of infective endocarditis and post-aortic valve replacement using echocardiography is important for both, diagnosing P-MAIVF and preventing serious complications such rupture and angina.
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Varga A, Tilea I, Tatar CM, Iancu DG, Jiga MA, Dumbrava RA, Pop M, Suciu H. Native Aortic Valve Endocarditis Complicated by Splenic Infarction and Giant Mitral-Aortic Intervalvular Fibrosa Pseudoaneurysm-A Case Report and Brief Review of the Literature. Diagnostics (Basel) 2021; 11:diagnostics11020251. [PMID: 33562151 PMCID: PMC7914780 DOI: 10.3390/diagnostics11020251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2021] [Revised: 01/27/2021] [Accepted: 02/03/2021] [Indexed: 11/24/2022] Open
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.
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Affiliation(s)
- Andreea Varga
- Department ME2, Faculty of Medicine in English, “G. E. Palade” University of Medicine, Pharmacy, Science and Technology of Targu Mures, 540142 Targu Mures, Romania;
- Department of Cardiology II, Emergency Clinical County Hospital, 540042 Targu Mures, Romania;
| | - Ioan Tilea
- Department of Cardiology II, Emergency Clinical County Hospital, 540042 Targu Mures, Romania;
- Department M4, Clinical Sciences, Faculty of Medicine, “G. E. Palade” University of Medicine, Pharmacy, Science and Technology of Targu Mures, 540142 Targu Mures, Romania
| | - Cristina Maria Tatar
- Department M4, Clinical Sciences, Faculty of Medicine, “G. E. Palade” University of Medicine, Pharmacy, Science and Technology of Targu Mures, 540142 Targu Mures, Romania
- Department of Internal Medicine II, Emergency Clinical County Hospital, 540042 Targu Mures, Romania; (D.G.I.); (M.A.J.); (R.A.D.)
- Correspondence: ; Tel.: +4-0744252037
| | - Dragos Gabriel Iancu
- Department of Internal Medicine II, Emergency Clinical County Hospital, 540042 Targu Mures, Romania; (D.G.I.); (M.A.J.); (R.A.D.)
- Doctoral School, “G. E. Palade” University of Medicine, Pharmacy, Science and Technology of Targu Mures, 540142 Targu Mures, Romania
| | - Maria Andrada Jiga
- Department of Internal Medicine II, Emergency Clinical County Hospital, 540042 Targu Mures, Romania; (D.G.I.); (M.A.J.); (R.A.D.)
- Doctoral School, “G. E. Palade” University of Medicine, Pharmacy, Science and Technology of Targu Mures, 540142 Targu Mures, Romania
| | - Robert Adrian Dumbrava
- Department of Internal Medicine II, Emergency Clinical County Hospital, 540042 Targu Mures, Romania; (D.G.I.); (M.A.J.); (R.A.D.)
- Doctoral School, “G. E. Palade” University of Medicine, Pharmacy, Science and Technology of Targu Mures, 540142 Targu Mures, Romania
| | - Marian Pop
- Department ME1, Faculty of Medicine in English, “G. E. Palade” University of Medicine, Pharmacy, Science and Technology of Targu Mures, 540142 Targu Mures, Romania;
- Department of Radiology and Medical Imaging, The Emergency Institute for Cardiovascular Diseases and Transplantation, 540136 Targu Mures, Romania
| | - Horatiu Suciu
- Department M3, Clinical and Surgery Sciences, Faculty of Medicine, “G. E. Palade” University of Medicine, Pharmacy, Science and Technology of Targu Mures, 540142 Targu Mures, Romania;
- Cardiac Surgery Clinic, The Emergency Institute for Cardiovascular Diseases and Transplantation, 540136 Targu Mures, Romania
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Hohri Y, Yamazaki S, Numata S, Yaku H. Delayed patch repair of a ruptured mitral subvalvular pseudoaneurysm caused by infective endocarditis: a case report. EUROPEAN HEART JOURNAL-CASE REPORTS 2020; 4:1-6. [PMID: 32974484 DOI: 10.1093/ehjcr/ytaa150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Revised: 03/31/2020] [Accepted: 05/05/2020] [Indexed: 11/13/2022]
Abstract
Background Ruptured subvalvular pseudoaneurysm is a rare but significantly fatal complication of infective endocarditis. We report a successful surgical case of ruptured subvalvular pseudoaneurysm with infective endocarditis. Case summary A 46-year-old man presenting with high fever was admitted to a local hospital. Physical examination revealed small erythema and petechiae on his lower limbs. Transthoracic echocardiogram did not show any visible vegetation and valvular disease; however, magnetic resonance imaging (MRI) showed multiple acute cerebral infractions, and methicillin-susceptible Staphylococcus aureus was detected in the blood culture. Infective endocarditis was suspected, and an antibacterial medication was initiated. Twelve days later, he suffered from a sudden cardiogenic shock due to cardiac tamponade. Bloody pericardial effusion (1600 mL) was drained, and his condition improved substantially. Transoesophageal echocardiography after pericardial drainage revealed severe mitral regurgitation and a subvalvular aneurysm at the posteromedial side of the mitral annulus; these were not detected at the time of admission. He was transferred to our hospital for surgery; however, since fresh cerebral bleeding was observed in MRI, the surgery was delayed. Three weeks later, after confirming that the blood culture was negative for any growth, patch repair of the subvalvular pseudoaneurysm and mitral valve repair were performed. Post-operatively, no complication or arrhythmia was observed; he was discharged 25 days later. Discussion We report a rare case of successful delayed surgery for a ruptured subvalvular pseudoaneurysm at the posteromedial side of the mitral annulus, which presented complications for infective endocarditis by S. aureus.
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Affiliation(s)
- Yu Hohri
- Department of Cardiovascular Surgery, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kawaramachi Hirokoji, Kamigyo-ku, Kyoto 602-8566, Japan
| | - Sachiko Yamazaki
- Department of Cardiovascular Surgery, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kawaramachi Hirokoji, Kamigyo-ku, Kyoto 602-8566, Japan
| | - Satoshi Numata
- Department of Cardiovascular Surgery, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kawaramachi Hirokoji, Kamigyo-ku, Kyoto 602-8566, Japan
| | - Hitoshi Yaku
- Department of Cardiovascular Surgery, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kawaramachi Hirokoji, Kamigyo-ku, Kyoto 602-8566, Japan
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Ahmed A, Shivaram P, Zakaria D. Pseudoaneurysm of the mitral-aortic intervalvular fibrosa following endocarditis and aortic valve surgery in an infant-Case report and exhaustive systematic review of pediatric cases. Echocardiography 2020; 37:1495-1505. [PMID: 32860460 DOI: 10.1111/echo.14824] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2019] [Revised: 07/25/2020] [Accepted: 07/25/2020] [Indexed: 12/27/2022] Open
Abstract
Pseudoaneurysm of the mitral-aortic intervalvular fibrosa (P-MAIVF) continues to be a rare diagnosis in children. Etiology, presentation, and management strategies are considerably different from adults. We report a fatal case of P-MAIVF with classical transthoracic and transesophageal echocardiographic findings complemented by CT imaging. The natural course of uncomplicated/asymptomatic P-MAIVF is largely unknown since most patients are offered surgery. We present an extensive literature review of pediatric P-MAIVF and highlight important differences from the adult form of this disease.
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Affiliation(s)
- Aziez Ahmed
- Division of Pediatric Cardiac Critical Care, Children's Heart Center, Yale New Haven Children's Hospital, Yale University School of Medicine, New Haven, CT, USA
| | - Pushpa Shivaram
- Department of Pediatric Cardiology, Augusta University, Augusta, GA, USA
| | - Dala Zakaria
- Department of Pediatrics, Division of Cardiology, University of Arkansas for Medical Sciences and Arkansas Childrens Hospital, Little Rock, AR, USA
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14
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Apostolidou E, Beale C, Poppas A, Stockwell P. Pseudoaneurysm of the Mitral-Aortic Intervalvular Fibrosa: A Case Series with Literature Review. ACTA ACUST UNITED AC 2017; 1:221-226. [PMID: 30062286 PMCID: PMC6058760 DOI: 10.1016/j.case.2017.07.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
P-MAIVF is usually a complication of endocarditis or aortic valve surgery. It is promptly recognized on transesophageal echocardiography. It may cause symptoms and complications that warrant surgical intervention. Surgical intervention remains the recommended management for P-MAIVF.
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Affiliation(s)
- Eirini Apostolidou
- Section of Cardiology, Brown University, Rhode Island Hospital, Providence, Rhode Island
| | - Charles Beale
- Section of Cardiology, Brown University, Rhode Island Hospital, Providence, Rhode Island
| | - Athena Poppas
- Section of Cardiology, Brown University, Rhode Island Hospital, Providence, Rhode Island
| | - Philip Stockwell
- Section of Cardiology, Brown University, Rhode Island Hospital, Providence, Rhode Island
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Harrington JK, Glickstein J, Shah A. Congenital pseudoaneurysm of the mitral-aortic intervalvular fibrosa: a case report. Cardiol Young 2017; 27:1-4. [PMID: 28552080 DOI: 10.1017/s1047951117000890] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
The mitral-aortic intervalvular fibrosa is an area of fibrous continuity between the mitral and aortic valves. We present the first case of a congenital pseudoaneurysm in this region, detected prenatally as an isolated cardiac defect, which was followed-up conservatively postnatally. The diagnosis was confirmed by echocardiogram demonstrating blood flow into the pouch during systole and into the left ventricular outflow tract during diastole. The infant has been followed-up with serial echocardiograms demonstrating stable size and appearance of the lesion, without signs of obstruction, making close continued observation a reasonable approach.
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Affiliation(s)
- Jamie K Harrington
- Department of Pediatrics,Division of Pediatric Cardiology,College of Physicians & Surgeons,Columbia University Medical Center,New York,NY,United States of America
| | - Julie Glickstein
- Department of Pediatrics,Division of Pediatric Cardiology,College of Physicians & Surgeons,Columbia University Medical Center,New York,NY,United States of America
| | - Amee Shah
- Department of Pediatrics,Division of Pediatric Cardiology,College of Physicians & Surgeons,Columbia University Medical Center,New York,NY,United States of America
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16
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Abdallah H, Michetti J, Demers P. Fistula formation following repair of a pseudoaneurysm of the mitral-aortic intervalvular fibrosa - A rare complication. J Cardiol Cases 2017; 15:170-172. [PMID: 30279771 DOI: 10.1016/j.jccase.2017.01.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2016] [Revised: 11/04/2016] [Accepted: 01/20/2017] [Indexed: 11/17/2022] Open
Abstract
The mitral-aortic intervalvular fibrosa is an avascular fibrous structure connecting the mitral and aortic annuli that is prone to pseudoaneurysm formation. Pseudoaneurysm of the mitral-aortic intervalvular fibrosa is a known complication of many conditions such as infective endocarditis and valvular surgery. It requires surgical correction. Its long-term consequences are little known. We present in this report the case of a 62-year-old male with history of pseudoaneurysm of the mitral-aortic intervalvular fibrosa repair and redo mitral and aortic prosthetic valve replacements. After five years of asymptomatic follow-up, the patient presented with sudden-onset heart failure. Echocardiographic investigation demonstrated two aorto-atrial fistulae at the site of his previous repair and adequate function of both prosthetic valves. The fistulae were repaired and the prosthetic valves were left in place. This represents a potential late surgical complication of pseudoaneurysm of the mitral-aortic intervalvular fibrosa. <Learning Objectives: This case report describes a rare complication occurring many years after the repair of a pseudoaneurysm of the mitral-aortic intervalvular fibrosa. Surgical and follow-up history is discussed to familiarize clinicians with this atypical presentation type.>.
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Affiliation(s)
- Hassane Abdallah
- Department of Cardiac Surgery, Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada
- Université de Sherbrooke, Sherbrooke, Quebec, Canada
| | | | - Philippe Demers
- Department of Cardiac Surgery, Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada
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Gil J, Antunes H, Marmelo B, Abreu L, Goncalves ML, Dos Santos LF, Cabral JC. Septic Shock of Unknown Origin: A Case Report of a Pseudoaneurysm of the Mitral-Aortic Intervalvular Fibrosa. J Clin Med Res 2017; 9:225-228. [PMID: 28179972 PMCID: PMC5289144 DOI: 10.14740/jocmr2903w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/10/2017] [Indexed: 11/21/2022] Open
Abstract
Pseudoaneurysm of the mitral-aortic intervalvular fibrosa (P-MAIVF) is a rare complication of infective endocarditis and trauma, particularly of aortic valve surgery. Clinical symptoms are usually unspecific and generally due to complications. Transesophageal echocardiography (TEE) is the most commonly used exam to diagnose P-MAIVF. The main echocardiographic feature is the presence of a cavity communicating with the left ventricular outflow tract that expands during systole and collapses during diastole. Most frequent complications are formation of a fistulous tract and compression of adjacent structures. Surgical correction is usually the treatment of choice. The authors describe a case of a female patient with a septic shock of unclear origin. After antibiotic therapy and organ-supporting measures without apparent improvements, a TEE revealed infective endocarditis, complicated with P-MAIVF. Despite adequate treatment, the patient did not survive for long enough to be submitted to surgical repair.
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Affiliation(s)
- Julio Gil
- Cardiology Department, Tondela-Viseu Hospital Centre, Viseu, Portugal
| | - Hugo Antunes
- Cardiology Department, Tondela-Viseu Hospital Centre, Viseu, Portugal
| | - Bruno Marmelo
- Cardiology Department, Tondela-Viseu Hospital Centre, Viseu, Portugal
| | - Luis Abreu
- Cardiology Department, Tondela-Viseu Hospital Centre, Viseu, Portugal
| | | | | | - Jose Costa Cabral
- Cardiology Department, Tondela-Viseu Hospital Centre, Viseu, Portugal
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18
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Characteristics and outcomes of patients with postoperative cardiovascular pseudoaneurysms. J Thorac Cardiovasc Surg 2017; 153:43-50. [DOI: 10.1016/j.jtcvs.2016.08.065] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2016] [Revised: 08/18/2016] [Accepted: 08/30/2016] [Indexed: 11/23/2022]
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19
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Arroja JD, Hachulla AL, Ellenberger C, Müller H. Multimodality imaging evaluation of a mitro-aortic fibrosa pseudoaneurysm fistulizing into both atria. Echocardiography 2017; 34:139-140. [DOI: 10.1111/echo.13399] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Affiliation(s)
- Jose David Arroja
- Cardiology Department; Geneva University Hospital; Geneva Switzerland
| | | | | | - Hajo Müller
- Cardiology Department; Geneva University Hospital; Geneva Switzerland
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20
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Chidambarathanu S, Raja V, Suresh I. Congenital pseudoaneurysm of mitral-aortic intervalvular fibrosa masquerading as left atrial mass in fetal life. Ann Pediatr Cardiol 2017; 10:72-74. [PMID: 28163433 PMCID: PMC5241850 DOI: 10.4103/0974-2069.197062] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
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.
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Affiliation(s)
- Shanthi Chidambarathanu
- Fetal Cardiology Unit and Pediatric Cardiac Services, Mediscan Systems, Chennai, Tamil Nadu, India
| | - Vijayalakshmi Raja
- Fetal Cardiology Unit and Pediatric Cardiac Services, Mediscan Systems, Chennai, Tamil Nadu, India
| | - Indrani Suresh
- Fetal Cardiology Unit and Pediatric Cardiac Services, Mediscan Systems, Chennai, Tamil Nadu, India
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21
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Lee JS, Kim WS, Ko SM, Shin JK. Organizing Thrombus Mimicking a Cardiac Tumor Located at the Mitral-Aortic Intervalvular Fibrosa. THE KOREAN JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 2016; 49:42-5. [PMID: 26889446 PMCID: PMC4757397 DOI: 10.5090/kjtcs.2016.49.1.42] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/11/2014] [Revised: 12/07/2014] [Accepted: 12/08/2014] [Indexed: 11/16/2022]
Abstract
Thrombosis at the left ventricular outflow tract occurs without any detectable heart disease or predisposing factors only extremely rarely. A 48-year-old male visited Konkuk University Medical Center with loss of consciousness one month prior to presentation. Before he visited our hospital, he had been diagnosed with a cardiac tumor, which was located between the left atrium and posterior aortic root, and which was adjacent to both the aortic and mitral valves. Cardiac transplantation was recommended at the other hospital because of the high risk of cardiac dysfunction induced by both aortic and mitral valvular dysfunction after surgical resection. Based on preoperative transthoracic echocardiography, cardiac computed tomography, cardiac magnetic resonance imaging, and intra-operative transesophageal echocardiography, we considered it to be a benign tumor. Complete resection was achieved and the pathology confirmed organizing thrombus. We report a case of organizing thrombus mimicking a cardiac tumor, which was located at the mitral-aortic intervalvular fibrosa of the left ventricular outflow tract without any heart disease.
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Affiliation(s)
- Ji Seong Lee
- Department of Thoracic and Cardiovascular Surgery, Konkuk University Medical Center, Konkuk University School of Medicine
| | - Wan Seop Kim
- Department of Pathology, Konkuk University Medical Center, Konkuk University School of Medicine
| | - Seong Min Ko
- Department of Radiology, Konkuk University Medical Center, Konkuk University School of Medicine
| | - Je Kyoun Shin
- Department of Thoracic and Cardiovascular Surgery, Konkuk University Medical Center, Konkuk University School of Medicine
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22
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Kanza RE, Allard C, Berube M. Cardiac findings on non-gated chest computed tomography: A clinical and pictorial review. Eur J Radiol 2016; 85:435-51. [DOI: 10.1016/j.ejrad.2015.11.042] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2015] [Revised: 11/27/2015] [Accepted: 11/28/2015] [Indexed: 10/22/2022]
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23
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Hasebe H, Takanohashi A, Shirota K, Nakamura H. Infective Endocarditis with Intermittent Atrioventricular Block and Pseudoaneurysm of the Mitral-aortic Intervalvular Fibrosa in a Patient with Severe Aortic Stenosis. Intern Med 2016; 55:2825-2829. [PMID: 27725543 PMCID: PMC5088544 DOI: 10.2169/internalmedicine.55.7031] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Atrioventricular (AV) block and pseudoaneurysm of the mitral-aortic intervalvular fibrosa (P-MAIVF) are rare complications of infective endocarditis (IE). A 72-year-old man with severe aortic stenosis was hospitalized due to IE. After admission, intermittent AV block and P-MAIVF were noted. Interestingly, an accelerated junctional rhythm was observed during the process of AV block resolution. Elective surgery, which included patch closure of the fistula and replacement of the aortic valve, was successfully performed. The patient has remained in good condition without the recurrence of AV block. This case report describes a rare comorbidity of AV block and P-MAIVF in a patient with aortic valve IE.
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Affiliation(s)
- Hideyuki Hasebe
- Division of Arrhythmology, Shizuoka Saiseikai General Hospital, Japan
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Pseudoaneurysm of the mitral-aortic intervalvular fibrosa and its deadly complication. Int J Cardiol 2015; 195:17-8. [PMID: 26011407 DOI: 10.1016/j.ijcard.2015.05.103] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2015] [Accepted: 05/17/2015] [Indexed: 11/21/2022]
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Pereira L, Machado A, Oliveira J, Almeida P, Bettencourt P. Infective Endocarditis Presenting as Acute Renal Failure and Unusual Complications. Intern Med 2015; 54:1259-63. [PMID: 25986267 DOI: 10.2169/internalmedicine.54.3236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Infective endocarditis can be a diagnostic challenge. Few cases have so far reported infective endocarditis presenting as renal failure. Pseudoaneurysms of the mitral-aortic intervalvular fibrosa and splenic abscess are rare complications of infective endocarditis. We herein report a case of an 80-year-old man admitted due to anorexia, malaise, edema of the legs and renal failure. A progressive degradation of the patient's renal function was documented and hemodialysis was started. Blood cultures revealed the presence of Enterococcus faecalis, and the patient was treated with ampicillin and gentamicin. The transesophageal echocardiogram findings showed pseudoaneurysms of the mitral-aortic intervalvular fibrosa and in the aortic root wall. Due to abdominal pain, an abdominal CT scan was performed and showed a cystic lesion compatible with splenic abscess. The patient received 6 weeks of antibiotic treatment. There was progressive clinical improvement and regression of the splenic abscess, but no recovery of the renal function. This report illustrates an unusual clinical presentation of infective endocarditis with unusual complications that were successfully treated with antibiotics.
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Affiliation(s)
- Luciano Pereira
- ����Nephrology Research and Development Unit, Faculty of Medicine, University of Porto, 2.Nephrology Department, São João Hospital Center, Portugal
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Pseudoaneurysm of the mitral-aortic intervalvular fibrosa. A new comprehensive review. Herz 2014; 40 Suppl 2:182-9. [PMID: 25468033 DOI: 10.1007/s00059-014-4185-z] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2014] [Revised: 10/13/2014] [Accepted: 11/02/2014] [Indexed: 10/24/2022]
Abstract
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.
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Zhao S, Chen X, Yang X. Prenatal Diagnosis of an Aneurysm of the Mitral-Aortic Intervalvular Fibrosa. Echocardiography 2014; 32:716-9. [PMID: 25409769 DOI: 10.1111/echo.12841] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Affiliation(s)
- Sheng Zhao
- Department of Diagnostic Ultrasonography; Hubei Maternal & Children's Hospital; Wuhan China
| | - Xinlin Chen
- Department of Diagnostic Ultrasonography; Hubei Maternal & Children's Hospital; Wuhan China
| | - Xiaohong Yang
- Department of Diagnostic Ultrasonography; Hubei Maternal & Children's Hospital; Wuhan China
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Abstract
OBJECTIVES This publication aims to report the cases of four children with pseudoaneurysm of the mitral-aortic intervalvular fibrosa and carry out a review of the literature. BACKGROUND Pseudoaneurysm of the mitral-aortic intervalvular fibrosa is a very rare anomaly in children. It can be either congenital or acquired, namely, after bacterial endocarditis or cardiac trauma. This pathology does not usually cause specific symptoms but its outcome may be potentially fatal. METHODS We report the cases of four patients presenting with pseudoaneurysm of the mitral-aortic intervalvular fibrosa, referred for treatment in a paediatric cardiology clinic. Patient clinical notes were retrospectively reviewed for aetiology, clinical presentation, diagnostic work-up, surgical treatment, and follow-up. Literature on the subject was extensively reviewed. RESULTS In three patients, pseudoaneurysm of the mitral-aortic intervalvular fibrosa was acquired, being secondary to bacterial endocarditis in two cases and establishing after mitral surgery in another case. The remaining patient had a "congenital" aetiology - no other cause could be traced. The diagnosis was achieved by transthoracic echocardiography for all patients, and confirmed in all by trans-oesophageal echocardiography, to better define morphological details and to access flow into the aneurysmal formation. All patients were submitted to corrective cardiac surgery. Of the patients, three survived and were cured by surgery, staying asymptomatic, and one died after repeated interventions, for persistent endocarditis. CONCLUSIONS Pseudoaneurysm of the mitral-aortic intervalvular fibrosa is a rare but potentially fatal anomaly. In our experience, surgical cure was achieved for the majority of the cases, except for a case for which infection could not be locally eradicated, leading to multiple reinterventions.
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Subacute Staphylococcus epidermidis Bacterial Endocarditis Complicated by Mitral-Aortic Intervalvular Fibrosa Pseudoaneurysm. Case Rep Cardiol 2012; 2012:467210. [PMID: 24826254 PMCID: PMC4007790 DOI: 10.1155/2012/467210] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2012] [Accepted: 11/20/2012] [Indexed: 12/02/2022] Open
Abstract
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.
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