Intervalvular Fibrosa Aneurysm

E-chocardiography Journal: Alphabetical List / Chronological List / Home Page

Interact Cardiovasc Thorac Surg. 2008 Aug;7(4):727-9. Epub 2008 May 20.
Intervalvular fibrosa pseudoaneurysm with projectile shunt flow to left atrium.
Ueno T, Sakata R, Iguro Y, Yamamoto H.
Department of Cardiovascular Surgery, Kagoshima University Graduate School of Medical and Dental Sciences, 8-35-1 Sakuragaoka, Kagoshima City, Kagoshima 890-8520, Japan.

We report a case of intervalvular fibrosa pseudoaneurysm, causing massive shunt flow from the left ventricle below the left coronary cusp to the left atrium above the anterior mitral annulus, which was clearly demonstrated on preoperative three-dimensional transesophageal echocardiography. Superior extension of the right-sided left atriotomy toward the pseudoaneurysm, combined with transection of aorta and main pulmonary artery, provided its sufficient exposure. Its opening to the left ventricle was closed with a patch, leaving no residual shunt flow.

J Am Soc Echocardiogr. 2008 Feb;21(2):187.e3-5. Epub 2007 Aug 1.
Unusual cardiac complications of Staphylococcus aureus endocarditis.
Kunavarapu C, Olkovsky Y, Lafferty JC, Homayuni AR, Mohan SS, McGinn J.
Department of Cardiology, Medical College of Georgia, Augusta, Georgia 30912, USA.

Bacterial endocarditis is a complex disease that is associated with significant morbidity and mortality. Staphylococcus aureus is an organism commonly responsible for acute bacterial infective endocarditis. Patients many times develop an acute fulminant infection resulting in multiple complications, even in the face of adequate therapy. We report an unusual case of S. aureus acute bacterial infective endocarditis in an immunocompromised patient resulting in multiple cardiac complications, including bacterial pericarditis with effusion, mycotic aneurysm of one of the coronary arteries, a valvular vegetation leading to an aneurysmal dilatation at the mitral-aortic junction (intervalvular fibrosa), and a fistulous communication between the left ventricle and left atrium. We present detailed echocardiographic images of these anomalies, which were subsequently confirmed intraoperatively. The patient underwent open heart surgery with pericardial patch repair of the mitral-aortic intervalvular fibrosa aneurysm and fistula.

Pediatr Radiol. 2008 Oct 23.
MDCT evaluation of congenital mitral-aortic intervalvular fibrosa aneurysm: implications for the aetiology and differential diagnosis.
Tsai IC, Fu YC, Lin PC, Lin MC, Jan SL.
Department of Paediatrics and Institute of Clinical Medicine, National Yang Ming University, Taipei, Taiwan.

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.

J Clin Ultrasound. 2006 Sep;34(7):361-4.
An unusual complication after aortic valve replacement.
Gupta R, Jammula P, Huang MH, Atar S, Ahmad M.
Division of Cardiology, The University of Texas Medical Branch, 301 University Boulevard, 4.148 McCullough Building, Galveston, TX 77555-0766, USA.

Pseudoaneurysm of the mitral-aortic intervalvular fibrosa, though rare, can occur after aortic valve replacement. We report an asymptomatic patient who developed this unusual complication and describe the use of transesophageal and 3-dimensional echocardiography to help confirm the diagnosis.

Rev Esp Cardiol. 2005 Dec;58(12):1473-5.
Percutaneous closure of pseudoaneurysm of the mitral-aortic intervalvular fibrosa
Jiménez Valero S, García E, González Pinto A, Delcán JL.
Unidad de Hemodinámica y Cardiología Intervencionista, Hospital de Madrid Montepríncipe, Madrid, Spain.

Pseudoaneurysm of the mitral-aortic intervalvular fibrosa is an uncommon event, which is usually secondary to endocarditis of the aortic valve. Its clinical evolution is variable and potentially serious complications can occur. Therefore, surgical treatment is usually recommended. To the best of our knowledge, this is the first description of percutaneous treatment of this disease.

J Heart Valve Dis. 2004 Jan;13(1):145-8.
Left ventricular outflow tract pseudoaneurysm after aortic valve replacement: case report.
Aoyagi S, Fukunaga S, Otsuka H, Akaiwa K, Yokokura Y, Yokokura H.
Department of Surgery, Kurume University School of Medicine, Kurume, Japan.

A 68-year-old woman was admitted for angina pectoris and general fatigue without symptoms or signs of infective endocarditis. The patient had undergone re-replacement of an aortic prosthetic valve three months previously. Transesophageal echocardiography revealed an echo-free cavity in the mitral-aortic intervalvular fibrosa region just below the aortic annulus, communication of the echo-free cavity with the left ventricular outflow tract, and turbulent flow into the cavity. Left ventriculography revealed a cavity that arose just below the aortic prosthetic valve, and which expanded in systole and collapsed in diastole. Coronary angiography showed significant stenosis of the proximal right coronary artery, but neither stenoses nor compression were found in the left coronary artery. Patch closure of the pseudoaneurysm and aortic root replacement using a Freestyle valve with reconstruction of the coronary arteries were successfully performed. Surgical trauma to the intervalvular fibrosa during removal of the original prosthetic valve may have caused pseudoaneurysm formation in this patient.

J Am Soc Echocardiogr. 2003 Aug;16(8):894-6.
Stroke in patient with an intervalvular fibrosa pseudoaneurysm and aortic pseudoaneurysm.
Koch R, Kapoor A, Spencer KT.
Department of Cardiology, University of Chicago, Chicago, Illinois 60637, USA.

We describe a case of an intervalvular fibrosa pseudoaneurysm associated with a cerebrovascular accident. This case in unusual as the likely source of embolic stroke was thrombus from within the pseudoaneurysm. Transesophageal echocardiography also demonstrated a communication between the intervalvular fibrosa and the proximal aorta.

Clin Med Res. 2003 Jan;1(1):49-52.
Pseudoaneurysm of mitral-aortic intervalvular fibrosa.
Tak T.
Department of Cardiology, Marshfield Clinic, Marshfield, WI 54449, USA.

Pseudoaneurysm of the mitral-aortic intervalvular fibrosa (MAIVF) is one of the rare complications of infective endocarditis. Echocardiography plays an important role in the diagnosis of this condition. Transesophageal echocardiography (TEE) is generally superior to the transthoracic approach in the evaluation of the complications resulting from infective endocarditis. In this report, we discuss a case of infective endocarditis complicated by the development of a pseudoaneurysm of the MAIVF. The anatomic relationship of structures contiguous to the MAIVF and the salient echocardiographic findings of this clinical condition are presented. At surgery the diagnosis was confirmed and appropriate treatment instituted. The postoperative course was uncomplicated.

J Am Soc Echocardiogr. 2002 Jul;15(7):743-5.
False aneurysm of the mitral-aortic intervalvular fibrosa after uncomplicated aortic valve replacement.
Rodrigues Borges AG, Suresh K, Mirza H, Katz JP, Simandl SL, Bilfinger T, Cohn PF.
Echocardiography Laboratory, Division of Cardiology, State University of New York, Stony Brook, New York 11794, USA.

False aneurysms of the mitral-aortic intervalvular fibrosa are rare and usually complicate aortic valve endocarditis. We report a case of a false aneurysm of the mitral-aortic intervalvular fibrosa after recent bioprosthetic aortic valve replacement in the absence of endocarditis.

J Am Soc Echocardiogr. 2002 Jan;15(1):96-8.
Pseudoaneurysm of the mitral-aortic fibrosa: myocardial ischemia secondary to left coronary compression.
Almeida J, Pinho P, Torres JP, Garcia JM, Maciel MJ, Lima CA, Bastos PT, Gomes MR.
Center of Thoracic Surgery, S. João Hospital, Oporto, Portugal.

In the current study we describe the cases of 2 patients operated on for left-sided endocarditis, who later had myocardial ischemia develop secondary to left coronary artery compression from a pseudoaneurysm of the mitral-aortic fibrosa. Because the symptoms of angina persisted despite medical treatment, both patients had second surgeries. Myocardial revascularization was performed in 1 patient; the other patient, who had a severely depressed ventricular function, was given an orthotopic cardiac transplant.

Eur J Cardiothorac Surg. 2000 Jun;17(6):757-9.
Pseudoaneurysm in the mitral-aortic intervalvular fibrosa. A cause of mitral regurgitation.
Espinosa-Caliani JS, Montijano A, Melero JM, Montiel A.
Cardiology Department, Málaga University Hospital Virgen de la Victoria, Málaga University School of Medicine, Málaga, Spain.

Left ventricular outflow tract pseudoaneurysm is an uncommon but potentially catastrophic complication of aortic valve surgery, aortic valve endocarditis or chest trauma. We describe a case of a left ventricular outflow tract pseudoaneurysm 1 month after an aortic valve replacement that caused a systolic compression of mitral valve and a severe regurgitation. The diagnosis was confirmed using transoesophageal echocardiography, magnetic resonance image and intraoperative endoscopy. Surgical repair of the pseudoaneurysm corrected the mitral regurgitation.

Echocardiography. 1999 Apr;16(3):253-257.
Pseudoaneurysm of the Mitral-Aortic Intervalvular Fibrosa: A Long-Term Complication of Infective Endocarditis.
Agirbasli M, Fadel BM.
Stanford University, Falk Cardiovascular Research Center, 300 Pasteur Drive, Stanford, CA 94305-5406.

Pseudoaneurysms of the left ventricle are rare and may occur as a result of transmural myocardial infarction, chest trauma, cardiac surgery, or endocarditis. Although postinfarction pseudoaneurysms commonly arise in the mid and apical segments of the left ventricle, those resulting from endocarditis arise at the base of the heart. Here we report the case of a patient who developed a large pseudoaneurysm as a complication of aortic valve endocarditis. The pseudoaneurysm had two uncommon features; it originated from the intervalvular fibrous body connecting the mitral to the aortic valve, and it eroded through the chest wall, resulting in blood drainage through the skin.

J Am Soc Echocardiogr. 1995 Sep-Oct;8(5 Pt 1):753-6.
Coronary artery compression caused by a large pseudoaneurysm of the mitral-aortic intervalvular fibrosa.
Bier AJ, Lamphere JA, Daily PO.
Sharp Memorial Hospital, San Diego, CA, USA.

An unusual late complication of bacterial endocarditis is described. Four years after diagnosis and treatment, a patient is seen with coronary artery compression caused by a large pseudoaneurysm of the mitral-aortic intervalvular fibrosa. The utility of transesophageal echocardiography in diagnosis and surgical management is emphasized.

J Am Soc Echocardiogr. 1995 Mar-Apr;8(2):211-4.
A case of mitral-aortic intervalvular fibrosa aneurysm with unique flow patterns and long-term natural survival.
Pai RG, Ortega V, Ferry DR.
Jerry L. Pettis VA Hospital, Loma Linda, CA 92357, USA.

We report a patient with a large aneurysm of mitral-aortic intervalvular fibrosa as a complication of prosthetic aortic valve endocarditis diagnosed on transthoracic echocardiography. This aneurysm began to expand with atrial systole, filled fully during ventricular systole, and collapsed in diastole on transesophageal examination. The patient refused corrective surgery and has survived on medical treatment for close to 2 years.

Am Heart J. 1995 Feb;129(2):417-21.
Angina caused by systolic compression of the left coronary artery as a result of pseudoaneurysm of the mitral-aortic intervalvular fibrosa.
Parashara DK, Jacobs LE, Kotler MN, Yazdanfar S, Spielman SR, Janzer SF, Bemis CE.
Department of Medicine, Albert Einstein Medical Center, Temple University School of Medicine, Philadelphia, PA 19141.

J Am Coll Cardiol. 1995 Jan;25(1):137-45.
Pseudoaneurysms of the mitral-aortic intervalvular fibrosa: dynamic characterization using transesophageal echocardiographic and Doppler techniques.
Afridi I, Apostolidou MA, Saad RM, Zoghbi WA.
Department of Medicine, Baylor College of Medicine, Methodist Hospital, Houston, Texas 77030.

OBJECTIVES. The aim of this study was to provide a detailed description of echocardiographic and Doppler features of pseudoaneurysms involving the mitral-aortic intervalvular fibrosa and to compare echocardiographic and aortographic findings. BACKGROUND. Infection of the aortic valve may spread to the aortic annulus, resulting in ring abscesses or pseudoaneurysms, or both, of the intervalvular fibrosa, which can alter patient management and prognosis. METHODS. The echocardiographic and Doppler findings of 20 patients with pseudoaneurysms or ring abscesses, or both, were reviewed and compared with surgical and aortographic results. RESULTS. A total of 23 lesions were identified, of which 16 were intervalvular pseudoaneurysms, and 7 were ring abscesses. Transthoracic echocardiography detected 43% of the lesions, whereas transesophageal echocardiography identified 90% (p < 0.01). The most distinct feature of the pseudoaneurysms was marked pulsatility, with systolic expansion and diastolic collapse (mean systolic area [+/- SD] 4.1 +/- 3.4 cm2 vs. diastolic mean area 1.8 +/- 2.2 cm2, p < 0.05). Using color Doppler, two types were identified: unruptured pseudoaneurysms (n = 9), which communicated only with the left ventricular outflow tract and had a distinct flow pattern, and ruptured pseudoaneurysms (n = 7), which, in addition, communicated with the left atrium or aorta. Compared with pseudoaneurysms, ring abscesses were smaller and nonpulsatile and showed either no flow or continuous systolic and diastolic flow, the site of paravalvular aortic insufficiency. In 10 patients who underwent aortography, three lesions were identified, and findings were concordant with echocardiography. However, in seven patients aortographic findings were normal, whereas echocardiography identified intervalvular pseudoaneurysms, all of which were documented at operation. CONCLUSIONS. Intervalvular pseudoaneurysms are more frequently detected by transesophageal echocardiography than by aortography or transthoracic examination and exhibit distinct dynamic features and Doppler patterns that can further help characterize cavitary lesions in the aortic root and guide appropriate surgical intervention.

Circulation. 1992 Aug;86(2):353-62.
Transesophageal echocardiographic recognition of subaortic complications in aortic valve endocarditis. Clinical and surgical implications.
Karalis DG, Bansal RC, Hauck AJ, Ross JJ Jr, Applegate PM, Jutzy KR, Mintz GS, Chandrasekaran K.
Department of Internal Medicine (Cardiology) Hahnemann University, Philadelphia, Pa.

BACKGROUND. Secondary involvement of the mitral-aortic intervalvular fibrosa and the anterior mitral leaflet (subaortic structures) can occur in patients with aortic valve endocarditis. The secondary involvement of these structures occurs as a result of direct extension of the infection from the aortic valve or as a result of an infected aortic regurgitant jet striking the ventricular surfaces of the mitral-aortic intervalvular fibrosa and the anterior mitral leaflet. The abscess of mitral-aortic intervalvular fibrosa can expand to form an aneurysm. Subsequently, this mitral-aortic intervalvular fibrosa aneurysm can develop a perforation and communicate with the left atrium, resulting in the systolic regurgitation of blood from the left ventricular outflow tract into the left atrium. Secondary infection can also occur on the ventricular surface of the anterior mitral leaflet and result in the formation of an aneurysm or perforation of anterior mitral leaflet. METHODS AND RESULTS. This study examines the utility of transesophageal echocardiography in the detection of these subaortic complications in 55 consecutive patients with aortic valve endocarditis. A total of 24 patients (44%) had involvement of subaortic structures, including four with an abscess in the mitral-aortic intervalvular fibrosa, four with mitral-aortic intervalvular fibrosa aneurysm, seven with perforation of the mitral-aortic intervalvular fibrosa with communication into the left atrium, two with an aneurysm of the anterior mitral leaflet, and seven with perforation of the anterior mitral leaflet. The transesophageal echocardiographic findings were confirmed at surgery in 20 patients and at necropsy in two. By comparison, transthoracic echocardiography visualized these lesions in five of 24 patients (21%), including none of four with mitral-aortic intervalvular fibrosa abscesses, two of four with mitral-aortic intervalvular fibrosa aneurysms, one of seven with mitral-aortic intervalvular fibrosa perforations, one of two with anterior mitral leaflet aneurysms, and one of seven anterior mitral leaflet perforations. Eccentric mitral regurgitation-type systolic jets were noted in eight additional patients by transthoracic color flow imaging, and this finding suggested the possibility of these unusual subaortic complications. If these patients are included, then transthoracic echocardiography suggested the presence of these subaortic complications in 13 of 24 patients (54%). CONCLUSIONS. The results indicate that 1) involvement of the subaortic structures in patients with aortic valve endocarditis may be more common than previously recognized, 2) patients with aortic valve endocarditis and eccentric jets of mitral regurgitation on transthoracic echocardiography should undergo further evaluation by transesophageal echocardiography to exclude these unusual complications, 3) precise recognition of these complications is of value in the optimal medical and surgical management of these patients, and 4) these complications may be responsible for unexplained congestive heart failure and hemodynamic deterioration in some patients with aortic valve endocarditis.

G Ital Cardiol. 1990 Sep;20(9):873-7.
Post-traumatic pseudoaneurysm of the mitral-aortic intervalvular fibrosa
Chiari E, Cefis M, Alfieri O.
Divisione di Riabilitazione Cardiologica, Ospedale Civile di Brescia, Presidio di Fasano.

The case of a patient with large pseudoaneurysm of the mitral-aortic intervalvular fibrosa following a blunt chest trauma is presented. A two dimensional echocardiographic study revealed a large aneurysmal sac situated between the posterior aortic root and the left atrium, which expanded in systole and partially collapsed in diastole. An echo-free space which represented the mouth of the aneurysm was seen just below the posterior aortic cusp in the junctional zone between the two valves, called mitral-aortic intervalvular fibrosa. Nuclear magnetic resonance imaging showed a better resolution of the echocardiographic feature. Cardiac catheterization and surgery confirmed the diagnosis.

Back to E-chocardiography Home Page.

The contents and links on this page were last verified on November 25, 2008.