Mitral-aortic Intervalvular Fibrosa Pseudoaneurysm with Dual Fistula and Complete AV Block after Aortic Valve Replacement in a Patients with Infective Endocarditis of Aortic Valve

Three‐Dimensional Echocardiographic Delineation of an Acquired Aorto‐Left Atrial Fistula Complicating Native Aortic Valve Endocarditis – “Advantage of Three Dimensions”

“…The thin and fibrous junctional tissue in the left ventricular outflow tract (LVOT) between the left half of the noncoronary cusp and the adjacent third of the left coronary cusp and the anterior mitral leaflet is termed as MAIVF . Due to the relative avascularity of the MAIVF, it is susceptible to infection originating from the aortic valve endocarditis resulting in the formation of abscess or pseudoaneurysm or a fistulous communication between the LVOT and the LA . The secondary involvement of MAIVF in aortic valve IE may be due to direct extension of the infection or due to the infected aortic regurgitation jet striking the subvalvular structures.…”

“…2 Due to the relative avascularity of the MAIVF, it is susceptible to infection originating from the aortic valve endocarditis resulting in the formation of abscess or pseudoaneurysm or a fistulous communication between the LVOT and the LA. 4 The sec- ondary involvement of MAIVF in aortic valve IE may be due to direct extension of the infection or due to the infected aortic regurgitation jet striking the subvalvular structures. TTE is less sensitive than TEE for detection of subaortic complications in IE of the aortic valve.…”