Pseudoaneurysm of the mitral‐aortic intervalvular fibrosa following endocarditis and aortic valve surgery in an infant—Case report and exhaustive systematic review of pediatric cases

Abstract

Pseudoaneurysm of the mitral‐aortic intervalvular fibrosa (P‐MAIVF) continues to be a rare diagnosis in children. Etiology, presentation, and management strategies are considerably different from adults. We report a fatal case of P‐MAIVF with classical transthoracic and transesophageal echocardiographic findings complemented by CT imaging. The natural course of uncomplicated/asymptomatic P‐MAIVF is largely unknown since most patients are offered surgery. We present an extensive literature review of pediatric P‐MAIVF and highlight important differences from the adult form of this disease.

Infective Endocarditis by Moraxella Species: A Systematic Review

“…Additionally, one study was included after reference search of the aforementioned studies. Finally, 27 met the present study’s inclusion criteria [ 16 , 17 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 ]. The review process is graphically presented in Figure 1 .…”

Prenatally diagnosed pseudoaneurysm of mitral–aortic intervalvular fibrous area

“…Pseudoaneurysms can be seen and diagnosed on fetal echocardiography and postnatal transthoracic echocardiography. In some cases, transesophageal echocardiography is used in older patients to demonstrate better the connection to the LVOT, assess the relationship with surrounding structures and examine for presence of thrombus, but it is typically not necessary for the diagnosis 7 .…”

“…Pseudoaneurysm of this area is rare and has been reported mostly in adult patients following trauma, cardiac surgery or endocarditis 1,3 . Several case studies have described its occurrence in children following cardiac surgery 4,5 or endocarditis 6,7 , with few case reports describing the congenital nature of these pseudoaneurysms 5,6,[8][9][10] . Prenatal diagnosis of pseudoaneurysm of the MAIVF indicates that this abnormality can be congenital.…”

“…Despite the fact that the majority of pseudoaneurysms are discovered incidentally, they do require monitoring and can result in complications, such as compression or obstruction of surrounding structures, formation of fistula, intra-aneurysm clot formation and embolization, endocarditis, rupture and death [1][2][3]7,11 . Some pseudoaneurysms are small and do not interfere with associated structures, while others are large and may cause obstruction of structures such as pulmonary veins (Case 3), mitral valve, LVOT (Case 2), coronary arteries 1 and superior vena cava 12 .…”

Infected Pseudoaneurysm in Congenital Heart Disease

“…Pseudoaneurysm is a well-recognized but unusual complication of infective endocarditis and can occur within the heart (eg, ventricular or mitral-aortic intervalvular fibrosa, right ventricle to pulmonary artery conduit) or at the level of the great arteries (eg, aortic root, descending aorta) ( 4 , 5 , 6 ). In the setting of infection, vulnerable regions of the heart likely develop weakening that leads to outpouching and ultimately to contained rupture.…”