Echocardiographic Diagnosis and Outcome of Pseudoaneurysm of the Mitral-Aortic Intervalvular Fibrosa

Abstract

Pseudoaneurysm of the mitral-aortic intervalvular fibrosa (P-MAIVF) is a rare but potentially fatal entity. Early diagnosis and surgical treatment are particularly important to decrease risk of mortality.The purpose of this study was to explore the echocardiographic characteristics and outcome of P-MAIVF and to evaluate the potential application of three-dimensional (3D) echocardiography in the evaluation of P-MAIVF.Clinical and echocardiographic characteristics were retrospectively evaluated in 9 patients with P-MAIVF, 5 of them assessed by 3D echocardiography. P-MAIVF was identified on echocardiography and located in the posterior aspect of the aortic root, expanding in systole and collapsing in diastole. Of the 9 cases examined, 8 were associated with endocarditis and 1 was caused by radio frequency catheter ablation of atrial fibrillation. Five cases were associated with bicuspid aortic valve, and rupture of P-MAIVF was identified in 3 patients. The morphology of P-MAIVF was clearly demonstrated on 3D echocardiography in 5 cases.In conclusion, echocardiography provides a useful tool in the diagnosis of P-MAIVF. Color Doppler flow imaging can ease identification of the ostium in cases of ruptured pseudoaneurysms. Three-dimensional echocardiography shows the relationship between P-MAIVF and the adjacent anatomic structures.

Pseudoaneurysm of the mitral‐aortic intervalvular fibrosa following endocarditis and aortic valve surgery in an infant—Case report and exhaustive systematic review of pediatric cases

“…References of all included articles were searched for any additional reports. There were a total of 46 pediatric patients aged 0–21 years in 35 reports, including our case 1–34 . P‐MAIVF cause was assigned based on the original authors of the reports.…”

Pseudoaneurysm of the Mitral-Aortic Fibrosa in the Absence of Valvulitis

“…It has been postulated that aortic valve endocarditis predisposes MAIVF to pseudoaneurysm commonly from 1) direct extension of infection through the aortic wall or 2) indirectly through increased aortic regurgitant jet pressure striking the walls. The avascular nature renders it more prone to infection, leading to subaortic abscesses [ 1 , 7 ]. In patients with aortic valve surgery, local traction and trauma can lead to disruption of the MAIVF over time, eventually leading to pseudo aneurysm, even without signs of infection.…”

“…The mitral aortic intervalvular fibrosa (MAIVF) is a thin fibrous tissue located between the aortic and mitral valves. It forms a junction between the left half of the non-coronary cusp, the adjacent left coronary cusp of the aortic valve and the anterior leaflet of the mitral valve [ 1 ]. The roof comprises pericardium and the ventricular side serves as the posterior surface of the left ventricular outflow tract (LVOT).…”

Mitral‐aortic intervalvular fibrosa pseudoaneurysm causing compression of superior vena cava and right atrium

“…Transesophageal echocardiography (TEE) mid-esophageal four chamber and long-axis view showed the pseudoaneurysm of MAIVF ( Figure 1A Systolic expansion and diastolic collapse are needed to be shown to distinguish pseudoaneurysm of MAIVF from aortic root abscesses. 4 We used multimodality imaging techniques to diagnose because a detailed examination is essential for surgeons for preoperative planning. Asymptomatic pseudoaneurysm of MAIVF cases can be followed by a medical approach.…”