Pseudoaneurysm of mitral-aortic intervalvular fibrosa in a child: Demonstration by MDCT and MRI

Abstract

Subaortic left ventricular outflow tract pseudoaneurysms are rare lesions that are associated with aortic valve diseases, infective endocarditis, trauma or surgery. We present dynamic multidetector computerized tomography and cine magnetic resonance imaging features of a case of subaortic aneurysm arising from interaortic-mitral valvular region in a child with past history of infective endocarditis.

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

“…Some of these lesions are thought to be congenital in origin [ 2 ]. Being a relatively avascular area, it is prone to weakening and abscess collection after aortic [ 8 , 9 ] and, less commonly, mitral valve surgeries [ 10 , 11 ].…”

Pseudoaneurysm in the Mitral–Aortic Intervalvular Fibrosa—Case Report and Literature Review

“…Bicuspid aortic valve (BAV) is the most common valvular congenital heart defect and can be complicated by IE in 7–30% of cases . Patients with BAV have a congenital weakness of the MAIVF and hence a propensity to the formation of pseudoaneurysms . The aortic regurgitant jet may also be a contributing factor by adding further insult to the already compromised MAIVF region as well as by establishing a secondary infected site in this region …”

“…Echocardiography usually establishes the diagnosis. In one series of 16 patients with intervalvular pseudoaneurysms, TEE had a sensitivity of 90% while TTE had a sensitivity of only 43% . Visualization of the echo‐free space with systolic expansion and diastolic collapse of the aneurysmal structure is an important diagnostic feature.…”

“…The exact localization of the opening and neck of the aneurysm is essential. Computed tomography and MRI both provide excellent multiplanar and 3D images of the aneurysm, its relationship with the coronary arteries, aortic root, and cardiac chambers, and are invaluable to the operating surgeon . Coronary angiography is an essential part of the preoperative evaluation to rule out coronary compression as well as atherosclerotic coronary disease.…”

“…In one series of 16 patients with intervalvular pseudoaneurysms, TEE had a sensitivity of 90% while TTE had a sensitivity of only 43%. 12 Visualization of the echo-free space with systolic expansion and diastolic collapse of the aneurysmal structure is an important diagnostic feature. However, this phenomenon can be less prominent in a patient with a fistulous communication, like in our case, because the pressure variations within the aneurysm are blunted.…”