Pseudoaneurysm in the Intervalvular Mitral-Aortic Region After Endocarditis and Prosthetic Aortic Valve Replacement
A 50-year-old man was referred for transesophageal echocardiography. The patient had undergone a prosthetic aortic valve replacement (Medtronic Hall A 23) 5 months previously because of severe aortic regurgitation due to staphylococcal endocarditis. The postoperative course was complicated by a fever that lasted 3 months. Actually, the multiplane transesophageal echocardiography examination revealed an echo-free pouch located posteriorly, in the mitral aortic intervalvular region that was bounded by the base of the anterior mitral leaflet, the posterior aortic root, and the medial wall of the left atrium. A marked pulsatility was detected, with the cavitary lesion expanding in early systole and collapsing in diastole (Figure⇓, top). The maximal cavity area was 3.35 cm2, and the minimal area was 1.85 cm2. The cavitary pouch opened to the left ventricular outflow tract through a fistulous dehiscence in the mitral-aortic continuity as shown by color-flow Doppler imaging (Figure⇓, bottom). No signs indicating a rupture of the lesion to the aorta or the left atrium were found. The characteristic pulsatile dynamic of the lesion during the cardiac cycle and the communication with the left ventricular outflow tract are criteria diagnostic of a pseudoaneurysm of the mitral-aortic intervalvular fibrosa.
The editor of Images in Cardiovascular Medicine is Hugh A. McAllister, Jr, MD, Chief, Department of Pathology, St Luke’s Episcopal Hospital and Texas Heart Institute, and Clinical Professor of Pathology, University of Texas Medical School and Baylor College of Medicine.
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