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

Abstract

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.

Prospective Evaluation of the Weekend Effect on Mortality Outcomes in Aortic Dissection

“…In particular, the occurrence of preoperative and postoperative events must be taken into account when analyzing mortality and its reduction in relation to inpatient and outpatient care. To identify and manage risk factors and circumstances that could influence a hospitalized patient's mortality, this evaluation is required [33][34][35][36]. Due to the high rate of death associated with this disease, the treatment approach in the case of an emergency presentation of a patient with an aortic dissection must be concentrated on the segments that are eligible for therapeutic intervention.…”

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

“…Some P-MAIVFs are simple pseudoaneurysms while others are linked to the left atrium or Valsalva sinus. P-MAIVF is occasionally associated with severe complications such as rupture and angina by compression of the coronary artery [1][2][3][4]. In a review, other authors had recommended surgical repair for P-MAIVF with or without symptoms to prevent rupture of P-MAIVF [2,4].…”

“…We experienced a case of P-MAIVF that was diagnosed accidentally; the patient was asymptomatic. Some studies have reviewed clinical cases of P-MAIVF [1][2][3][4], and the association between P-MAIVF and IE, AVR, and bicuspid aortic valves (BAVs). Although our case had no clinical symptoms, a large P-MAIVF could rupture and compress the coronary artery, possibly resulting in fatal complications.…”

Clinical, Hematological, Biochemical and Radiological Characteristics for Patients With Splenic Infarction: Case Series With Literature Review

“…Infection Cytomegalovirus [6][7][8] Epstein-Barr virus [9][10][11][12][13][14][15] Infective endocarditis [16][17][18][19][20][21][22] COVID-19 [23][24][25][26][27][28][29][30][31][32][33][34][35] Dengue virus [36] Mycoplasma pneumoniae [37,38] Malaria [39,40] Scrub typhus [41,42] Aspergillus pericarditis [43] Babesiosis [44] Malignancy including neoplasm and myeloproliferative diseases…”