Coronary artery compression caused by a large pseudoaneurysm of the mitral-aortic intervalvular fibrosa

Aortomitral intervalvular fibrosa aneurysm-a rare case

Aortomitral intervalvular fibrosa aneurysm is a rare entity but a life-threatening condition. We present a case of young male presented with NYHA functional class IV dyspnea where aneurysm ruptured into the left atrium.

Pseudoaneurysm Arising from Mitral Aortic Intervalvular Fibrosa (P-MAIVF) Communicating with Left Atrium (LA): Multiple Detector Computed Tomography (MDCT) Evaluation

BACKGROUND

The entity pseudoaneurysm arising from the mitral aortic intervalvular fibrosa (P-MAIVF) is a rare cardiac finding caused by multiple factors. This entity is usually diagnosed with echocardiography and confirmed with cardiac computed tomography (CT).

CASE REPORT

We presented a case of congenital P-MAIVF communicating with the left atrium (LA) and an aberrant right subclavian artery, misdiagnosed as primary mitral regurgitation (MR) in transthoracic echocardiogram (TTE) due to relative contraindications to transesophageal echocardiogram (TEE), revealed in a hemophilic patient, and diagnosed with cardiac CT.

CONCLUSIONS

In conclusion, cardiac CT plays a definitive role not only in anatomical assessment and confirmation of the lesion but also in primary diagnostics in patients suspected of MAIVF - especially those with relative and absolute contraindications to TEE.

[Pseudo-aneurysm of mitro-aortic continuity: a rare complication after aortic valve replacement]

Pseudo-aneurysm of the fibrous continuity zone between the aortic and mitral valves, the so-called "mitral-aortic intervalvular fibrosa" is a rare complication of acute infective endocarditis, rarely after an aortic valve replacement. We report the case of a large pseudo-aneurysm occurred in a 70-year-old man, who had a history of surgical aortic valve replacement 3 years before. There were no biological or clinical evidence for infective acute endocarditis. The originality of this observation can be summarized in three points: the late onset after surgery, the absence of any infectious context and the chronic nature of pseudo-aneurysm, without any complication during a follow-up of 12 months. Transesophageal echocardiography remains the best diagnostic tool.

Pseudoaneurysm of the mitral-aortic intervalvular fibrosa (MAIVF): A comprehensive review

Pseudoaneurysm in the region of the fibrous body between the mitral and aortic valve, the mitral-aortic intervalvular fibrosa (MAIVF), is a rare complication. The authors provide a comprehensive review of all relevant English-language articles published from 1966 to December 2009. Pseudoaneurysm of the MAIVF was identified in 88 patients in the medical literature and one from the authors' institution (total reported cases, 89). Endocarditis and aortic valve surgery were the most frequently associated causative factors. Symptoms and signs of infection, chest pain, heart failure or shortness of breath, and cerebrovascular accidents accounted for 77% of clinical presentations. The formation of a fistulous tract, coronary artery compression, and death were important described complications. Patients with ring abscesses in the MAIVF region and those with prosthetic aortic valves and histories of endocarditis are at higher risk for developing pseudoaneurysm of the MAIVF. Transesophageal echocardiography was able to identify all cases in which it was used. Surgical correction is the treatment of choice.

Large pseudoaneurysms of the mitral-aortic intervalvular fibrosa: long-term natural history without surgery in two patients

A pseudoaneurysm of the mitral-aortic intervalvular fibrosa is a well-described complication of aortic valve endocarditis and aortic valve replacement. It may occasionally cause complications, but it may also remain uncomplicated and asymptomatic for unknown periods. Although corrective surgery is commonly recommended, the appropriate therapeutic approach to this pathology is unclear. The current report describes two patients with large pseudoaneurysms of the mitral-aortic intervalvular fibrosa, who were treated conservatively without surgery without any adverse clinical events during long-term follow-up. Therefore, conservative follow-up of this pathology with echocardiographic monitoring appears to be a valid and safe alternative for surgery, especially in patients at high risk for surgical intervention.

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

BACKGROUND

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.

METHODS

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.

RESULTS

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.

CONCLUSIONS

clinical surveillance and serial imaging of MIAVF pseudoaneurysms may be considered an alternative to surgical management in select individuals.

An unusual complication after aortic valve replacement

Pseudoaneurysm of the mitral-aortic intervalvular fibrosa, though rare, can occur after aortic valve replacement. We report an asymptomatic patient who developed this unusual complication and describe the use of transesophageal and 3-dimensional echocardiography to help confirm the diagnosis.

Postoperative asystole in a vasculopathic man

We present a case of postoperative cardiac arrest caused by extrinsic occlusion of the right coronary artery by an aortic pseudoaneurysm. Extrinsic impingement upon the coronary arteries may result from several etiologies and lead to cardiac symptoms identical to those caused by intrinsic coronary disease. Extrinsic compression may be amenable to treatment with angioplasty or a combination of angioplasty and surgery.

Stroke in patient with an intervalvular fibrosa pseudoaneurysm and aortic pseudoaneurysm

We describe a case of an intervalvular fibrosa pseudoaneurysm associated with a cerebrovascular accident. This case in unusual as the likely source of embolic stroke was thrombus from within the pseudoaneurysm. Transesophageal echocardiography also demonstrated a communication between the intervalvular fibrosa and the proximal aorta.

Pseudoaneurysm of the mitral-aortic fibrosa: myocardial ischemia secondary to left coronary compression

In the current study we describe the cases of 2 patients operated on for left-sided endocarditis, who later had myocardial ischemia develop secondary to left coronary artery compression from a pseudoaneurysm of the mitral-aortic fibrosa. Because the symptoms of angina persisted despite medical treatment, both patients had second surgeries. Myocardial revascularization was performed in 1 patient; the other patient, who had a severely depressed ventricular function, was given an orthotopic cardiac transplant.

Transesophageal echocardiographic (TEE) evaluation of the aortic valve, left ventricular outflow tract, and pulmonic valve

The most important role of TEE in aortic valve disease is in the diagnosis of endocarditis and its complications. Examination of the annulus and subvalvular region is essential in any patient with possible aortic valve endocarditis. Assessment of the severity of aortic stenosis is a useful application of TEE when other data are either inconsistent or unavailable. TEE can provide a diagnosis of the origin of acute severe aortic insufficiency; this information may play a critical role in surgical planning. The diagnosis of a variety of aortic valve diseases can be made when TEE is performed to find an embolic source or to rule out dissection. In the case of mass lesions, such as papillary fibroelastomas and Libman-Sacks vegetations, the results of TEE carry major therapeutic implications. TEE offers generally excellent quality images of the LVOT and images of the RVOT and pulmonic valve that are superior to transthoracic echocardiography. The major clinical usefulness of TEE stems from its ability to identify pulmonic valve mass lesions and the causes of left and right ventricular outflow obstruction. TEE is also an important adjunct in the surgical management of left ventricular outflow obstruction.

Aneurysm of the mitral-aortic intervalvular fibrosa as a rare cause of angina pectoris: angiographic demonstration

Aneurysms of the mitral-aortic interventricular fibrosa (MAIF) are exceptionally rare complications, commonly following aortic valve endocarditis. This report describes the angiographic findings of such an aneurysm, in a patient who developed an uncommon symptomatology of unstable angina pectoris, caused by the aneurysm's expansion against the coronary arteries. Surgical treatment is also discussed.

Exercise for the older woman: choosing the right prescription

Many elderly women in industrially developed countries are at, or near to, functionally important strength related thresholds and so have either lost, or are in danger of losing, the ability to perform some important everyday tasks. The increased rate of healthcare expenditure due to loss of physical function is a major economic issue. Even though women make up most of the senior population, little current research on the impact of physical activity on strength and function in elderly people has included women. Elderly women typically have more barriers to participation in physical activity than do other groups and because of decreased participation, may possibly experience higher disability rates. Physical activity in old age may delay the progression of osteoporosis and is of paramount importance for maintaining the functional abilities needed to carry out daily tasks. Current research on exercise and the elderly population suggests that strength training may be the exercise mode of choice for maintenance of strength, physical function, bone integrity, and psychosocial health. This review summarises recent research on the impact of strength training on the fitness and health of elderly women and highlights considerations and potential barriers to physical activity that must be taken into account when planning exercise programmes for them.