Pseudoaneurysm of the Mitral-Aortic Intervalvular Fibrosa in a Patient After Radio Frequency Catheter Ablation of Atrial Fibrillation

Han, Jiancheng; He, Yun; Li, Zhian; Chen, Jian; Gu, Xiaoyan; Pei, Jin-feng; Xie, Jinjie; Kontos, Michael C.; Nixon, J.V.

doi:10.7863/jum.2009.28.2.249

Cited by 9 publications

(2 citation statements)

References 15 publications

(15 reference statements)

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“…The disease known as pseudoaneurysm of the mitral-aortic intervalvular fibrosa (PMAIF) is rare [ 1 , 2 ]. This pseudoaneurysm is located at the aortic mitral curtain (AMC), which is a delicate and fibrous membrane that is situated between the aortic valve (AV) and the mitral valve (MV) [ 3 ].…”

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confidence: 99%

Thirty-three-year follow-up of pseudoaneurysm of the mitral-aortic intervalvular fibrosa without surgical treatment: a case report and literature review

Mirhosseini,

Soltanipur,

Yarmohammadi

et al. 2024

J Cardiothorac Surg

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Background Pseudoaneurysm of the mitral-aortic intervalvular fibrosa (PMAIF) is a rare complication of infective endocarditis or aortic valve surgery. Surgical treatment is suggested, but the long-term follow-up of conservative management remains unclear. Case presentation A 33-year follow-up of a patient who developed PMAIF six years after aortic valve replacement is reported. The patient presented to our center with dyspnea, and the echocardiography revealed an ejection fraction of 20% and a PMAIF measuring 7 × 10 mm. Despite being advised to undergo surgery, the patient declined due to fear of surgical outcomes. Consequently, conservative treatment with close observation but without surgery was initiated. During the 33-year follow-up period, the patient did not experience any adverse health effects. Conclusion Surgical intervention should be considered whenever the PMAIF is diagnosed. However, in any case that the surgery was not applicable, conservative management might lead to long-term survival, based on this and similar case reports in the literature.

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Section: Introductionmentioning

confidence: 99%

Thirty-three-year follow-up of pseudoaneurysm of the mitral-aortic intervalvular fibrosa without surgical treatment: a case report and literature review

Mirhosseini,

Soltanipur,

Yarmohammadi

et al. 2024

J Cardiothorac Surg

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“…This case report addresses the role of RT3D Echo in the diagnosis of this rare clinical situation. This noninvasive, portable and fast diagnostic method provides complementary information to two‐dimensional echocardiography and can be as accurate as cardiac magnetic resonance imaging in the diagnosis of mitral subvalvular pseudoaneurysm 2–4 …”

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confidence: 99%

Subvalvular Mitral Pseudoaneurysm Evaluated by Three‐Dimensional Echo

et al. 2010

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A 23-year-old male patient presented with fever, weight loss, anorexia, and night sweats for 6 months, followed by progressive exertional dyspnea and cough. Transthoracic and transesophageal echocardiograms were performed, revealing a cavity (28 × 35 mm; area = 7.5 cm 2 ) ( Fig. 1A-C) related to the posterior leaflet of the mitral valve, suggestive of a subvalvular pseudoaneurysm associated with severe mitral regurgitation and pulmonary hypertension. A transthoracic real time, three-dimensional echo (RT3D Echo) provided a better imaging and detailed anatomic information about this finding ( Fig. 2A-C) (movie clip 1). Systolic flow communication between the left ventricle and the pseudoaneurysm was shown by a color Doppler examination. A cardiac magnetic resonance imaging was performed, which confirmed the findings of the echocardiographic examination (movie clip 2). The patient was discharged from the hospital, and after 6 months of antituberculosis treatment, he was referred for mitral valve repair. A resection of the pseudoaneurysm and a posterior annuloplasty were performed ( Fig. 3A and 3B). The patient's symptoms had improved, and he was discharged from the hospital 20 days after the surgery. Subvalvular mitral pseudoaneurysms are unusual findings, related mostly to mitral valve repair. Echocardiography plays a fundamental role in the diagnosis of these cases. Transthoracic bidimensional echocardiography and Doppler echocardiography are very useful tools for identifying the pseudoaneurysm, locating it and demonstrating the blood flow turbulence within the cardiac chambers. 1 In this case, the three-dimensional echocardiogram more precisely identified the pseudoaneurysm and the orifice that was allowing communication between the left ventricle and this structure. In addition, the RT3D Echo allowed a detailed anatomic evaluation of the pseudoaneurysm and its relationship to the mitral valve and the subvalvular apparatus to be made, facilitating better surgical planning. This case report addresses the role of RT3D Echo in the diagnosis of this rare clinical situation. This noninvasive, portable and fast diagnostic method provides complementary information to two-dimensional echocardiography and can be as accurate as cardiac magnetic resonance imaging in the diagnosis of mitral subvalvular pseudoaneurysm. 2-4 References 1. Du Toit HJ, Von Oppell UO, Hewitson J, et al: Left ventricular sub-valvular mitral pseudopseudoaneurysms. Interact Cardiovasc Thorac Surg 2003;2:547-551. 2. Liang D, Paloma A, Kuppahally SS, et al: Multiplanar visualization in 3D transthoracic echocardiography for precise delineation of mitral valve pathology. Echocardiography 2008;25:84-87. 3. Chen CC, Hsiung MC, Wei J, et al: Mitral annular subvalvular left ventricular aneurysm. Echocardiography 2005;22:434-437. 4. Han J, He Y, Li Z, et al: Pseudoaneurysm of the mitralaortic intervalvular fibrosa in a patient after radio frequency catheter ablation of atrial fibrillation. J Ultrasound Med 2009;28:249-251. 473

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Pseudoaneurysm of the mitral–aortic intervalvular fibrosa

Şahan¹,

Gül²,

Şahan³

et al. 2014

Herz

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Pseudoaneurysm of the mitral-aortic intervalvular fibrosa (P-MAIVF) is an infrequent but potentially life-threatening condition. Both transthoracic echocardiography (TTE) and transesophageal echocardiography (TEE) can detect P-MAIVF with sensitivity rates of 43 and 90 %, respectively. The typical finding of echocardiography is a pulsatile echo-free sac that expands in systole and collapses in diastole. Our review comprises 166 patients with P-MAIVF, including eight cases in our hospital and 158 cases from the literature. P-MAIVF is often associated with infection or surgical trauma. While it is likely to maintain an asymptomatic course, symptoms of shortness of breath, heart failure, valvular disease, chest pain, endocarditis, and cerebrovascular events are common clinical presentations. The recommended treatment is surgery. However, conservative therapy is an alternative approach for high-risk patients or when surgical treatment is refused. With the increasing incidence of cardiac surgery and infective endocarditis, a likely increment in the new diagnosis of pseudoaneurysm is expected.

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Pseudoaneurysm of the Mitral-Aortic Intervalvular Fibrosa in a Patient After Radio Frequency Catheter Ablation of Atrial Fibrillation

Cited by 9 publications

References 15 publications

Thirty-three-year follow-up of pseudoaneurysm of the mitral-aortic intervalvular fibrosa without surgical treatment: a case report and literature review

Thirty-three-year follow-up of pseudoaneurysm of the mitral-aortic intervalvular fibrosa without surgical treatment: a case report and literature review

Subvalvular Mitral Pseudoaneurysm Evaluated by Three‐Dimensional Echo

Pseudoaneurysm of the mitral–aortic intervalvular fibrosa

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