Pseudoaneurysm Arising from Mitral Aortic Intervalvular Fibrosa (P-MAIVF) Communicating with Left Atrium (LA): Multiple Detector Computed Tomography (MDCT) Evaluation

Abstract

SummaryBackgroundThe entity pseudoaneurysm arising from the mitral aortic intervalvular fibrosa (P-MAIVF) is a rare cardiac finding caused by multiple factors. This entity is usually diagnosed with echocardiography and confirmed with cardiac computed tomography (CT).Case ReportWe presented a case of congenital P-MAIVF communicating with the left atrium (LA) and an aberrant right subclavian artery, misdiagnosed as primary mitral regurgitation (MR) in transthoracic echocardiogram (TTE) due to relative contraindications to transesophageal echocardiogram (TEE), revealed in a hemophilic patient, and diagnosed with cardiac CT.ConclusionsIn conclusion, cardiac CT plays a definitive role not only in anatomical assessment and confirmation of the lesion but also in primary diagnostics in patients suspected of MAIVF – especially those with relative and absolute contraindications to TEE.

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

“… 1 P-MAIVF can also occur in patients without a prosthetic aortic valve, 11 being associated with chest trauma, 12 with Takayasu's arteritis 13 or congenital abnormality. 14 All patients in this study had their natural valves, which differs from previous reports. 9 , 10 The pathogenesis of P-MAIVF still remains largely unknown, but it has been speculated that it may result from either direct extension of endocarditis of the aortic valve or from an “infected” aortic regurgitant jet striking the walls of the LVOT.…”

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

“…During systole, the blood moves into the pseudoaneurysm, but during diastole the blood flows back into the LVOT. This finding can be blunted in the case of a fistulous communication between the atrial and ventricular cavity [ 11 ]. CT angiography is advantageous in the evaluation of valvular structures, atherosclerotic plaque and precise location of pseudoaneurysm [ 11 ].…”

“…This finding can be blunted in the case of a fistulous communication between the atrial and ventricular cavity [ 11 ]. CT angiography is advantageous in the evaluation of valvular structures, atherosclerotic plaque and precise location of pseudoaneurysm [ 11 ]. Cardiac CT and magnetic resonance imaging (MRI) can further delineate the lesions.…”