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.

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.

MDCT evaluation of congenital mitral-aortic intervalvular fibrosa aneurysm: implications for the aetiology and differential diagnosis

Mitral-aortic intervalvular fibrosa aneurysm is a rare disease whose aetiology remains a matter of debate. Here we present the youngest reported patient with the disease, a 6-month-old boy, without a history of infection, which supports a congenital origin as initially proposed. Multidetector-row CT (MDCT) surpassed echocardiography in delineating the intracardiac anatomical details with high spatial resolution, confirming the important problem-solving role of MDCT in the diagnosis of congenital heart disease.