title: Pseudoaneurysm of mitral-aortic intervalvular fibrosa: two case reports and review of literature.
abstract: The aim of this study was to identify the echocardiographic characteristics of pseudoaneurysm of the mitral-aortic intervalvular fibrosa, which is a rare and life-threatening complication of infective endocarditis. We have demonstrated the difference in clinical presentation and management of acute and chronic types of this pseudoaneurysm, together with a review of literature of the topic. We present two cases, one acute and the other an example of a chronic pseudoaneurysm of the mitral-aortic intervalvular fibrosa. The abscess may enlarge rapidly and rupture, resulting in haemorrhage with a catastrophic outcome. Rarely, the pseudoaneurysm will undergo a subclinical course, thicken and organize into a chronic aneurysm. Transoesophageal echocardiogram demonstrates a false lumen below the aortic valve annulus at the mitral-aortic intervalvular fibrosa with marked pulsatility with systolic expansion and diastolic collapse. The successful management of acute pseudoaneurysm necessitates extensive resection and replacement of the infected areas around the pseudoaneurysm. In chronic pseudoaneurysm, there is structural integrity around the calcified pseudoaneurysm, potentially minimizing the need for an extirpative surgery. Pseudoaneurysm of the mitral-aortic intervalvular fibrosa is a rare complication of infective endocarditis, but delay in diagnosis can lead to devastating outcome.
authors.affiliation: Department of Internal Medicine, Howard University Hospital, 2041 Georgia Avenue, NW, Washington, DC 20060, USA. takassim@live.com
authors.forename: Thaslim Ahamed
authors.initials: TA
authors.lastname: Kassim
authors.forename: Robert C
authors.initials: RC
authors.lastname: Lowery
authors.forename: Ali
authors.initials: A
authors.lastname: Nasur
authors.forename: Sanul
authors.initials: S
authors.lastname: Corrielus
authors.forename: Gaby
authors.initials: G
authors.lastname: Weissman
authors.forename: Pamela
authors.initials: P
authors.lastname: Sears-Rogan
authors.forename: Michael
authors.initials: M
authors.lastname: Greenberg
authors.forename: Steven
authors.initials: S
authors.lastname: Singh
mesh_terms: D017541:Aneurysm, False / Q000000981:diagnostic imaging* / Q000209:etiology; D017548:Echocardiography, Transesophageal; D004696:Endocarditis / Q000150:complications / Q000000981:diagnostic imaging*; D006322:Heart Aneurysm / Q000000981:diagnostic imaging* / Q000209:etiology; D006801:Humans; D008297:Male; D008875:Middle Aged