title: Repair of recurrent pseudoaneurysm of the mitral-aortic intervalvular fibrosa: role of transesophageal echocardiography.
abstract: Pseudoaneurysm of mitral-aortic intervalvular fibrosa (P-MAIVF) is a rare cardiac surgical condition. P-MAIVF commonly occurs as a complication of aortic and mitral valve replacement surgeries. The surgical trauma during replacement of the valves weakens the avascular mitral and aortic intervalvular area. We present a case of P-MAIVF recurrence 5 years after a primary repair. Congestive cardiac failure was the presenting feature with mitral and aortic regurgitation. In view of the recurrence, the surgical team planned for a double valve replacement. The sewing rings of the two prosthetic-valves were interposed to close the mouth of the pseudoaneurysm and to provide mechanical reinforcement of the MAIVF. Intra-operative transesophageal echocardiography (TEE) helped in delineating the anatomy, extent of the lesion, rupture of one of the pseudoaneurysm into left atrium and severity of the valvular regurgitation. Post-procedure TEE confirmed complete obliteration of the pseudoaneurysm and prosthetic valve function.
authors.affiliation: Department of Cardiac Anesthesia, Sri Jayadeva Institute of Cardiovascular Sciences and Research, Bengaluru, Karnataka, India.
authors.forename: Shreedhar S
authors.initials: SS
authors.lastname: Joshi
authors.forename: Ashwini
authors.initials: A
authors.lastname: Thimmarayappa
authors.forename: P S
authors.initials: PS
authors.lastname: Nagaraja
authors.forename: A M
authors.initials: AM
authors.lastname: Jagadeesh
authors.forename: Arul
authors.initials: A
authors.lastname: Furtado
authors.forename: Seetharam
authors.initials: S
authors.lastname: Bhat
mesh_terms: D000328:Adult; D017541:Aneurysm, False / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery*; D001021:Aortic Valve / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery*; D006348:Cardiac Surgical Procedures / Q000379:methods*; D002311:Cardiomyopathy, Dilated / Q000000981:diagnostic imaging / Q000601:surgery; D002315:Cardiopulmonary Bypass; D017548:Echocardiography, Transesophageal; D006349:Heart Valve Diseases / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery*; D019918:Heart Valve Prosthesis Implantation / Q000379:methods*; D006801:Humans; D008297:Male; D008943:Mitral Valve / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery*; D012008:Recurrence; D016896:Treatment Outcome