Mitro‐aortic fibrosa pseudoaneurysm and concomitant aortic stenosis: How to kill two birds with a stone

Boi, Alberto; Garau, Giovanni; Rossi, Angélica; Lixi, Giovanni; Laura, Armandi; Fele, G.; Cossa, Stefano; Matta, Gildo; Manconi, Manlio; Sanna, Francesco; Loi, Bruno

doi:10.1111/jocs.14807

Cited by 4 publications

(3 citation statements)

References 11 publications

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“…We speculate that prolonged antibiotic therapy administered after sternal dehiscence during the first hospitalization could have masked the classic TOE findings. Anecdotical case reports suggest percutaneous repair as a possible solution for the closure of pseudoaneurysm in some patients,[ 20 ] but the hemodynamic impact of the concomitant valvular detachment in our patient addressed the need of a more radical procedure. Valvular detachment is an infrequent complication of infective endocarditis, but it has been described in some isolated cases, with the direct involvement of the annular structures as its primary etiology.…”

Section: Discussionmentioning

confidence: 90%

There is Nothing More Invisible than the Obvious: A Case Summary and Literature Review

Alfieri,

Ianni,

Molisana

et al. 2023

Journal of Cardiovascular Echography

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Bioprosthetic valvular failure (BVF) is a pathological entity arising from a variety of conditions affecting prosthetic heart valves. It may present with an extremely varied pattern, and the identification of the exact etiology is vital to provide a prompt and adequate treatment. It is established that infective endocarditis mainly affects patients with intracardiac devices such as pacemakers or prosthetic valves, and it represents one of the principal mechanisms of BVF. Despite its high incidence, clinical presentations may be atypical, and a close monitoring is essential to prevent catastrophic consequences. We present the case of a partial valvular bioprosthesis detachment associated with a newly formed pseudoaneurysm due to a late infective endocarditis occurred after cardiac surgery, initially manifested with negative blood cultures and clinical findings. We also try to set up a literature review of the most common causes of valvular failure and pseudoaneurysm formation.

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Section: Discussionmentioning

confidence: 90%

There is Nothing More Invisible than the Obvious: A Case Summary and Literature Review

Alfieri,

Ianni,

Molisana

et al. 2023

Journal of Cardiovascular Echography

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show abstract

“…Few authors have described successful percutaneous device-therapy of P-MAIVF using various devices (coil embolization, septal occluder devices, vascular plugs, transapical implantation of an Edwards Sapien XT valve-in-valve fashion) as an alternative when surgery is not appropriate [32][33][34]. Recently, Boi et al reported the first successfully exclusion of a P-MAIVF by transapical transcatheter implantation of a balloon-expandable Edwards Sapien 3 Ultra valve in a 78-year-old man with concomitant severe aortic stenosis [35].…”

Section: Discussionmentioning

confidence: 99%

Native Aortic Valve Endocarditis Complicated by Splenic Infarction and Giant Mitral-Aortic Intervalvular Fibrosa Pseudoaneurysm—A Case Report and Brief Review of the Literature

et al. 2021

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Background: Pseudoaneurysm of the mitral-aortic intervalvular fibrosa (P-MAIVF) is an unusual complication related to various injuries or conditions which involve the mitro-aortic region; it communicates with the left ventricular outflow tract and is associated with a high-risk of redoubtable complications or sudden death. The cerebral and splenic localizations are frequently seen as manifestations of systemic embolism in infective endocarditis. Currently, there are no specific recommendations related to the diagnosis, management, treatment, or further evolution of patients with P-MAIVF and concomitant splenic infarction. This paper presents the case of a 43-year-old Caucasian woman with a late diagnosis of mixed bicuspid aortic valve disease, affected by an under-detected and undertreated episode of infective endocarditis leading to asymptomatic P-MAIVF. Prime clinical and imagistic diagnosis of splenic infarction indicated further extended investigations were required to clarify the source of embolism. Methods: Integrated multimodality imaging techniques confirmed the unexpected diagnosis of P-MAIVF. Results: The case had a fatal outcome following an uncomplicated yet laborious cardiac surgery. Patient death was attributed to a malignant ventricular arrhythmia. Conclusion: The present case raises awareness by highlighting an unexplained and unexpected splenic infarction association with P-MAIVF as a result of infective endocarditis related to mixed bicuspid aortic valve disease.

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“…Valero et al [13] reported percutaneous closure of P-MAIVF using the Amplatzer® Muscular VSD Occluder device. Boi et al reported that they performed transcatheter aortic valve implantation for AS and P-MAIVF [14].…”

Section: Discussionmentioning

confidence: 99%

Surgical treatment for accidentally discovered pseudoaneurysm of the mitral-aortic intervalvular fibrosa with bicuspid aortic valve, ascending aortic aneurysm, and myocardial ischemia: a case report

et al. 2021

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Background Pseudoaneurysm of the mitral-aortic intervalvular fibrosa (P-MAIVF) is a rare complication of infective endocarditis and aortic valve replacement. Ruptured P-MAIVF and angina due to compression of the coronary arteries are severe complications of this condition. Case presentation We report a case of P-MAIVF that was diagnosed accidentally during a routine checkup. The patient was asymptomatic; however, she had a systolic murmur. She had a history of infective endocarditis, which was treated conservatively without open-heart surgery. In addition, she was diagnosed with aortic valve stenosis, aortic valve regurgitation, bicuspid aortic valve, right coronary artery stenosis, and an ascending aortic aneurysm. She was treated with surgery, which involved patch closure of P-MAIVF with aortic valve replacement, coronary artery bypass grafting, and ascending aorta replacement. After the operation, echocardiography showed no leakage from the P-MAIVF. Conclusions It is necessary to have knowledge of P-MAIVF. Following up cases of infective endocarditis and post-aortic valve replacement using echocardiography is important for both, diagnosing P-MAIVF and preventing serious complications such rupture and angina.

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Mitro‐aortic fibrosa pseudoaneurysm and concomitant aortic stenosis: How to kill two birds with a stone

Cited by 4 publications

References 11 publications

There is Nothing More Invisible than the Obvious: A Case Summary and Literature Review

There is Nothing More Invisible than the Obvious: A Case Summary and Literature Review

Native Aortic Valve Endocarditis Complicated by Splenic Infarction and Giant Mitral-Aortic Intervalvular Fibrosa Pseudoaneurysm—A Case Report and Brief Review of the Literature

Surgical treatment for accidentally discovered pseudoaneurysm of the mitral-aortic intervalvular fibrosa with bicuspid aortic valve, ascending aortic aneurysm, and myocardial ischemia: a case report

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