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Pseudoaneurysm of mitral-aortic intervalvular fibrosa with rupture: a case report

Kosuke Nakata1,2, Shuji Moriyama3, Jun Takaki4

  • 1Department of Cardiovascular Surgery, Kumamoto Rosai Hospital, 1670 Takehara-Machi, Yatsushiro, Kumamoto, 866-8533, Japan. nakata.kosuke@kuh.kumamoto-u.ac.jp.

Surgical Case Reports
|December 3, 2023
PubMed
Abstract

Insights

A ruptured pseudoaneurysm of the mitral-aortic intervalvular fibrosa (MAIVF) is a rare, life-threatening complication, often linked to healed infective endocarditis. Prompt diagnosis and surgical repair are crucial for successful outcomes.

Area of Science:

  • Cardiology
  • Cardiac Surgery
  • Cardiovascular Pathology

Background:

  • Mitral-aortic intervalvular fibrosa (MAIVF) is a connective fibrous tissue between the anterior mitral leaflet and aortic valve.
  • Pseudoaneurysm of the MAIVF is an uncommon condition, frequently associated with infective endocarditis (IE) or surgical trauma.
  • Ruptured MAIVF pseudoaneurysms pose a significant risk of cardiovascular compromise.

Purpose of the Study:

  • To report a rare case of a ruptured pseudoaneurysm of the MAIVF.
  • To review existing literature on MAIVF pseudoaneurysms.
  • To highlight the importance of timely diagnosis and intervention for this condition.

Main Methods:

  • A 65-year-old male with moderate aortic regurgitation presented with fever, headache, and apraxia, diagnosed with intracranial hemorrhage.
  • Echocardiography revealed aorto-mitral discontinuity and severe regurgitation, initially suspected as AML rupture.
  • Intraoperative findings confirmed a ruptured MAIVF pseudoaneurysm, necessitating repair with a bovine pericardial patch, aortic valve replacement, and mitral annuloplasty.

Main Results:

  • The patient presented with symptoms of intracranial hemorrhage and was diagnosed with a ruptured MAIVF pseudoaneurysm.
  • Surgical repair involved a bovine pericardial patch, aortic valve replacement, and mitral annuloplasty.
  • The patient's condition was managed successfully, with uneventful recovery following elective surgical repair.

Conclusions:

  • Pseudoaneurysm of the MAIVF (P-MAIVF) is a rare but potentially fatal complication, often linked to healed infective endocarditis.
  • Timely diagnosis and prompt, appropriate therapeutic intervention are essential for managing ruptured MAIVF pseudoaneurysms.
  • This case underscores the need for vigilance in diagnosing and treating MAIVF pseudoaneurysms, even in the absence of active IE.
Keywords:
Infective endocarditisIntracranial hemorrhageMitral-aortic intervalvular fibrosaPseudoaneurysmRupture

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