Aneurysm of the Intervalvular Mitroaortic Fibrosa after Aortic Valve Replacement Diagnosed by Cardiovascular Magnetic Resonance Imaging

Abstract

P i c t u r e 1 . Ci n e g r a d i e n t s e q u e n c e i n l e f t v e n t r i c u l e o u t f l o w t r a c t v i e w t h a t s h o we d l o c a l i z e d p r o t r u s i o n o f t h e i n t e r v a l v u l a r mi t r o a o r t i c f i b r o s a wi t h d i a s t o l i c c o l l a p s e ( RiA 58-year-old woman was referred to our department to rule out atrial mass. Four weeks before presentation she had undergone aortic valve replacement for aortic stenosis with a biological prosthesis. The blood cultures were negative and there was no sign of endocarditis. Magnetic resonance imaging (MRI) demonstrated localized protrusion of the intervalvular mitroaortic fibrosa with diastolic collapse and pulsing in systole (Picture 1).Aneurysms of mitro-aortic intervalvular fibrosa (AMIF) are rare and usually complicate native and prosthetic aortic valve endocarditis. The incidence of AMIF after aortic replacement in the absence of endocarditis is unknown. Usually it results from partial detachment of the proximal suture line of the sewing ring. Early recognition of these aneurysms is imperative in order to prevent a potentially fatal outcome. MRI is the diagnostic technique of choice for prompt diagnosis and the timely institution of treatment, due to their relatively posterior location and complex anatomy.

Mitro-aortic aneurysms in children: single-centre experience and review of the literature

“…A percutaneous approach has also been successfully attempted and might be considered in very particular cases. 1 Rarely, cases may complicate and have a fatal outcome, especially in the presence of active endocarditis, 20,21 such as was the case for patient 4. Considering the fragile nature of the mitral-aortic intervalvular fibrosa with its potential for severe complications, and a truly unpredictable course, along with improved diagnostic tools and good, low-risk, surgical results, the authors propose that elective surgery should be offered to all children with this diagnosis.…”

Multimodality Cardiac Imaging of a Noninfectious Pseudoaneursym of the Mitral-Aortic Intervalvular Fibrosa

“…Although transthoracic and transesophageal echocardiograms are the initial diagnostic tools for PA-MAIF, due to their relatively posterior location and complex anatomy, the MRI and MDCT are selected as the diagnostic technique for prompt diagnosis and timely institution of treatment 3). With such techniques, a further evaluation of adjoining pseudoaneurysm is feasible, and planning of the proper surgical intervention4) is enabled.…”