A Case of Pseudoaneurysm of Mitral-Aortic Intervalvular Fibrosa after Aortic Valve Replacement / 日本心臓血管外科学会雑誌

The mitral-aortic intervalvular fibrosa (MAIF) is a fibrous skeleton between the mitral and aortic valves. We describe a case of a pseudoaneurysm of MAIF (MAIFPsA) 3 months after an aortic valve replacement. A 75-year-old man had undergone aortic valve replacement using a bioprosthesis (SJM Trifecta 23 mm). He developed congestive heart failure 3 months after surgery. Trans-esophageal echocardiography and multi-detector computed tomography detected a MAIFPsA and severe paravalvular leakage. The patient underwent a new operation. After the aortic prosthesis was removed, an orifice of the pseudoaneurysm, which was composed of the anterior mitral leaflet and the aortic annulus, were revealed. The defect was repaired with a bovine pericardial patch, sutured to the anterior mitral leaflet and aortic annulus. A new bioprosthesis (Carpentier-Edwards PERIMOUNT 21 mm) was implanted in the supra-annular position. His postoperative course was uneventful.

Mitral-Aortic Intervalvular Fibrosa Pseudoaneurysm

Pseudoaneurysm of the mitral aortic intervalvular fibrosa (MAIVF-P) usually ensues as a complication of endocarditis or aortic valve surgery. When large, symptomatic or related to complications (rupture, compression of adjacent structures, embolic events, mitral regurgitation or heart failure) it warrants surgical excision. The natural course of uncomplicated/asymptomatic MAIVF-Ps is largely unknown since most patients are offered surgery. Increased surgical risk imposed by repeat operations in the majority of these patients is an important consideration and conservative treatment should not be excluded in selected cases. Herein we present two illustrative cases of MAIVF-P manifesting with significant arrhythmogenesis and complex endocarditis respectively. Both patients were managed conservatively. By briefly reviewing the existing literature, we discuss important diagnostic and therapeutic issues for MAIVF-Ps. To our knowledge complex ventricular arrhythmia has not been previously described as a prominent manifestation of MAIVF-P.

Repair of recurrent pseudoaneurysm of the mitral-aortic intervalvular fibrosa: Role of transesophageal echocardiography.

Pseudoaneurysm of mitral‑aortic intervalvular fibrosa (P‑MAIVF) is a rare cardiac surgical condition. P‑MAIVF commonly occurs as a complication of aortic and mitral valve replacement surgeries. The surgical trauma during replacement of the valves weakens the avascular mitral and aortic intervalvular area. We present a case of P‑MAIVF recurrence 5 years after a primary repair. Congestive cardiac failure was the presenting feature with mitral and aortic regurgitation. In view of the recurrence, the surgical team planned for a double valve replacement. The sewing rings of the two prosthetic‑valves were interposed to close the mouth of the pseudoaneurysm and to provide mechanical reinforcement of the MAIVF. Intra‑operative transesophageal echocardiography (TEE) helped in delineating the anatomy, extent of the lesion, rupture of one of the pseudoaneurysm into left atrium and severity of the valvular regurgitation. Post‑procedure TEE confirmed complete obliteration of the pseudoaneurysm and prosthetic valve function.

Transesophageal echocardiography in surgical management of pseudoaneurysm of mitral-aortic intervalvular fibrosa with aneurysms of right sinus of Valsalva and left main coronary artery.

Pseudoaneurysm of mitral-aortic intervalvular fibrosa (MAIVF) is a rare complication associated with aortic and/or mitral valve surgery complicated by infective endocarditis. We report pseudoaneurysm of MAIVF in a young adult without overt cardiac disease or previous cardiac surgery. The patient had a rare combination of pseudoaneurysm of MAIVF impinging on anterior mitral leaflet causing moderate mitral regurgitation, right sinus of Valsalva aneurysm extending into interventricular septum, and left main coronary artery aneurysm. Transesophageal echocardiography helped in confirming the lesions, delineating the anatomy of all the lesions, and assessing the adequacy of surgical repair.

Mitral-aortic Intervalvular Fibrosa Pseudoaneurysm with Dual Fistula that Occurred in Prosthetic Aortic Valve Endocarditis

The Iinvolvement of subaortic structures in the aortic valve endocarditis appears more commonly than previously recognized. These subaortic complications are most commonly located in the mitral-aortic intervalvular fibrosa and may be presented as abscess, or as pseudoaneurysm with or without perforation. Perforated pseudoaneurysm can lead to the development of communication between the left ventricular outflow tract and various cardiac chambers, most commonly the left atrium. These complications are related with poor prognosis. Early and precise recognition of these complications is important for optimal treatment. At present, transesophageal echocardiography (TEE) has been validated as the technique of choice. We describe a case of infectious pseudoaneurysm of mitral-aortic intervalvular fibrosa featuring the connection of the fistulous simultaneously to the left atrium and aorta. In our case, accurate interpretation of TEE imaging revealing the subaortic structures was not so easy due to interference of both aortic and mitral prosthetic valves. We expect the further development of (Ed-confirming that here you don't intend, "We expect to further develop") TEE and other imaging modalities to substantially improve the future diagnosis of these undesirable complications.