Pseudoaneurysm of mitral-aortic intervalvular fibrosa with rupture: a case report
Abstract Background Mitral-aortic intervalvular fibrosa (MAIVF) is a fibrous region connecting the anterior mitral leaflet (AML) and aortic valve. Pseudoaneurysm of the MAIVF is a rare condition that has been reported as a sequela of infective endocarditis (IE) and surgical trauma. Here, we report a...
| Main Authors: | , , , , , , |
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| Format: | Article |
| Language: | English |
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SpringerOpen
2023-12-01
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| Series: | Surgical Case Reports |
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| Online Access: | https://doi.org/10.1186/s40792-023-01789-3 |
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| author | Kosuke Nakata Shuji Moriyama Jun Takaki Masahiro Takeo Hideki Doi Toshiyuki Matsumura Toshihiro Fukui |
| author_facet | Kosuke Nakata Shuji Moriyama Jun Takaki Masahiro Takeo Hideki Doi Toshiyuki Matsumura Toshihiro Fukui |
| author_sort | Kosuke Nakata |
| collection | DOAJ |
| description | Abstract Background Mitral-aortic intervalvular fibrosa (MAIVF) is a fibrous region connecting the anterior mitral leaflet (AML) and aortic valve. Pseudoaneurysm of the MAIVF is a rare condition that has been reported as a sequela of infective endocarditis (IE) and surgical trauma. Here, we report a case of a ruptured pseudoaneurysm of the MAIVF, along with some literature reviews. Case presentation A 65-year-old man diagnosed with moderate aortic regurgitation five years previously had a fever of unknown origin. He suddenly developed headache and apraxia and was transported to our hospital. He was diagnosed with intracranial hemorrhage and admitted. One week after admission, echocardiography revealed aorto-mitral discontinuity and protrusion with severe regurgitant flow from left ventricular outflow tract to the left atrium. The AML was suspected to have ruptured. However, intraoperatively, the AML structure was preserved. A ruptured pseudoaneurysm of the MAIVF was also observed. Therefore, we successfully performed pseudoaneurysm repair using a bovine pericardial patch, aortic valve replacement, and mitral annuloplasty. Conclusions P-MAIVF is a rare but potentially life-threatening complication of IE, for which timely diagnosis and prompt appropriate therapeutic intervention are required. In the present case, although neither obvious active IE nor history of previous IE could be identified, healed IE was considered based on the clinical course. The patient had intracranial hemorrhage (ICH) with well-controlled heart failure and underwent elective surgical repair more than one month after the onset of ICH, while the clinical course after the surgical procedure was uneventful. |
| first_indexed | 2024-03-09T01:15:36Z |
| format | Article |
| id | doaj.art-5ef32d579103417293f6d9ff4a392b5f |
| institution | Directory Open Access Journal |
| issn | 2198-7793 |
| language | English |
| last_indexed | 2024-03-09T01:15:36Z |
| publishDate | 2023-12-01 |
| publisher | SpringerOpen |
| record_format | Article |
| series | Surgical Case Reports |
| spelling | doaj.art-5ef32d579103417293f6d9ff4a392b5f2023-12-10T12:29:30ZengSpringerOpenSurgical Case Reports2198-77932023-12-01911610.1186/s40792-023-01789-3Pseudoaneurysm of mitral-aortic intervalvular fibrosa with rupture: a case reportKosuke Nakata0Shuji Moriyama1Jun Takaki2Masahiro Takeo3Hideki Doi4Toshiyuki Matsumura5Toshihiro Fukui6Department of Cardiovascular Surgery, Kumamoto Rosai HospitalDepartment of Cardiovascular Surgery, Kumamoto Rosai HospitalDepartment of Cardiovascular Surgery, Kumamoto University HospitalDepartment of Cardiology, Kumamoto Rosai HospitalDepartment of Cardiology, Kumamoto Rosai HospitalDepartment of Cardiology, Kumamoto Rosai HospitalDepartment of Cardiovascular Surgery, Kumamoto University HospitalAbstract Background Mitral-aortic intervalvular fibrosa (MAIVF) is a fibrous region connecting the anterior mitral leaflet (AML) and aortic valve. Pseudoaneurysm of the MAIVF is a rare condition that has been reported as a sequela of infective endocarditis (IE) and surgical trauma. Here, we report a case of a ruptured pseudoaneurysm of the MAIVF, along with some literature reviews. Case presentation A 65-year-old man diagnosed with moderate aortic regurgitation five years previously had a fever of unknown origin. He suddenly developed headache and apraxia and was transported to our hospital. He was diagnosed with intracranial hemorrhage and admitted. One week after admission, echocardiography revealed aorto-mitral discontinuity and protrusion with severe regurgitant flow from left ventricular outflow tract to the left atrium. The AML was suspected to have ruptured. However, intraoperatively, the AML structure was preserved. A ruptured pseudoaneurysm of the MAIVF was also observed. Therefore, we successfully performed pseudoaneurysm repair using a bovine pericardial patch, aortic valve replacement, and mitral annuloplasty. Conclusions P-MAIVF is a rare but potentially life-threatening complication of IE, for which timely diagnosis and prompt appropriate therapeutic intervention are required. In the present case, although neither obvious active IE nor history of previous IE could be identified, healed IE was considered based on the clinical course. The patient had intracranial hemorrhage (ICH) with well-controlled heart failure and underwent elective surgical repair more than one month after the onset of ICH, while the clinical course after the surgical procedure was uneventful.https://doi.org/10.1186/s40792-023-01789-3Mitral-aortic intervalvular fibrosaPseudoaneurysmRuptureInfective endocarditisIntracranial hemorrhage |
| spellingShingle | Kosuke Nakata Shuji Moriyama Jun Takaki Masahiro Takeo Hideki Doi Toshiyuki Matsumura Toshihiro Fukui Pseudoaneurysm of mitral-aortic intervalvular fibrosa with rupture: a case report Surgical Case Reports Mitral-aortic intervalvular fibrosa Pseudoaneurysm Rupture Infective endocarditis Intracranial hemorrhage |
| title | Pseudoaneurysm of mitral-aortic intervalvular fibrosa with rupture: a case report |
| title_full | Pseudoaneurysm of mitral-aortic intervalvular fibrosa with rupture: a case report |
| title_fullStr | Pseudoaneurysm of mitral-aortic intervalvular fibrosa with rupture: a case report |
| title_full_unstemmed | Pseudoaneurysm of mitral-aortic intervalvular fibrosa with rupture: a case report |
| title_short | Pseudoaneurysm of mitral-aortic intervalvular fibrosa with rupture: a case report |
| title_sort | pseudoaneurysm of mitral aortic intervalvular fibrosa with rupture a case report |
| topic | Mitral-aortic intervalvular fibrosa Pseudoaneurysm Rupture Infective endocarditis Intracranial hemorrhage |
| url | https://doi.org/10.1186/s40792-023-01789-3 |
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