Mitral-Aortic Intervalvular Fibrosa Pseudoaneurysm: A Rare and Life-Threatening Presentation

A 40-year-old male with no prior history of cardiac disease or other comorbidities presented to the emergency department with a history of high-grade intermittent fever and breathlessness for two weeks. Examination revealed a febrile patient who had features of mitral regurgitation and aortic regurgitation. A transthoracic echocardiogram (TTE) revealed vegetation in the anterior mitral leaflet, along with moderate aortic and mitral regurgitation and a ruptured aortic root abscess that formed dual fistulous tracts in the aortic root. An extremely uncommon complication of infective endocarditis affecting the aortic valve is the development of an abscess in the intervalvular fibrosa (IVF) dual fistula formation. A dual fistulous tract communicating with the aortic root and the ascending aorta is very sparsely described in the literature. A 64-slice computed coronary angiography confirmed a pseudoaneurysm posterior to the aortic root, communicating with the aortic root through a neck and with the left ventricular outflow tract.