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Alfieri M, Ianni U, Molisana M, Parato VM. There is Nothing More Invisible than the Obvious: A Case Summary and Literature Review. J Cardiovasc Echogr 2023; 33:195-198. [PMID: 38486694 PMCID: PMC10936702 DOI: 10.4103/jcecho.jcecho_50_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Accepted: 10/22/2023] [Indexed: 03/17/2024] Open
Abstract
Bioprosthetic valvular failure (BVF) is a pathological entity arising from a variety of conditions affecting prosthetic heart valves. It may present with an extremely varied pattern, and the identification of the exact etiology is vital to provide a prompt and adequate treatment. It is established that infective endocarditis mainly affects patients with intracardiac devices such as pacemakers or prosthetic valves, and it represents one of the principal mechanisms of BVF. Despite its high incidence, clinical presentations may be atypical, and a close monitoring is essential to prevent catastrophic consequences. We present the case of a partial valvular bioprosthesis detachment associated with a newly formed pseudoaneurysm due to a late infective endocarditis occurred after cardiac surgery, initially manifested with negative blood cultures and clinical findings. We also try to set up a literature review of the most common causes of valvular failure and pseudoaneurysm formation.
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Affiliation(s)
- Michele Alfieri
- Cardiology and Arrhythmology Clinic, Department of Cardiovascular Sciences, University Hospital “Ospedali Riuniti”, Ancona, Italy
- Department of Biomedical Sciences and Public Health, Marche Polytechnic University, Ancona, Italy
| | - Umberto Ianni
- Department of Biomedical Sciences and Public Health, Cardiology and Cardiac Rehabilitation Unit, Madonna del Soccorso Hospital, San Benedetto del Tronto, Italy
| | - Michela Molisana
- Department of Biomedical Sciences and Public Health, Cardiology and Cardiac Rehabilitation Unit, Madonna del Soccorso Hospital, San Benedetto del Tronto, Italy
| | - Vito Maurizio Parato
- Department of Biomedical Sciences and Public Health, Marche Polytechnic University, Ancona, Italy
- Department of Biomedical Sciences and Public Health, Cardiology and Cardiac Rehabilitation Unit, Madonna del Soccorso Hospital, San Benedetto del Tronto, Italy
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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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