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Ann Thorac Surg 2007;83:2233
© 2007 The Society of Thoracic Surgeons

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Images in Cardiothoracic Surgery

Delayed Pseudoaneurysm of the Mitral-Aortic Intervalvular Fibrosa

Department of Cardiac Surgery, Metropolitan Hospital, Athens, Greece

^_* Address correspondence to Dr Economopoulos, Metropolitan Hospital, 9 E Makariou at 1 Venizelou Str., Neo Falior, 18547, Greece. (Email: geconomo{at}otenet.gr).

A 41-year-old woman presented for evaluation of transient ischemic attacks. The patient had an aortic valve replacement 1 year prior due to bacterial endocarditis with a 21-mm bi-leaflet mechanical valve. Postoperative transthoracic echocardiographies at the time of discharge and at 6-month follow-up were without any pathologic findings.

A transesophageal echocardiogram showed the existence of a large pseudoaneurysm of the mitral-aortic intervalvular fibrous area with expansion during systole and collapse in diastole. No clots were visible inside the pseudo aneurysm sac, but it was in direct communication with the left ventricular outflow tract through an opening immediately below the previously implanted aortic prosthesis, which was well seated without any evidence of paravalvular leak (Fig 1).

View larger version (120K): [in this window] [in a new window]   Fig 1.

At surgery the aorta was opened with an "S"-type incision toward the noncoronary sinus. The aortic prosthesis was explanted, and the area of the mitral-aortic intervalvular fibrous was inspected. It was difficult to precisely locate the mouth of the pseudoaneurysm, and thus further visualization of the area with opening of the left atrium through the anterior mitral valve leaflet was performed. An area of thin endocardium that easily protruded in the left atrium when probing from the subannular aortic area was noted. The incision of the anterior mitral valve leaflet, the roof of the left atrium, and the aortotomy were closed with a tear-drop shaped, pericardium covered, synthetic patch with sutures of 4-0 Prolene (Ethicon, Somerville, NJ). A 23-mm mechanical bi-leaflet aortic prosthesis was implanted. The patient was weaned from cardiopulmonary bypass without difficulty, and she had an intraoperative transthoracic echocardiography showing complete closure of the pseudoaneurysm (Fig 2).

View larger version (127K): [in this window] [in a new window]   Fig 2.

This article has been cited by other articles:

				T. Ueno, R. Sakata, Y. Iguro, and H. Yamamoto Intervalvular fibrosa pseudoaneurysm with projectile shunt flow to left atrium Interactive CardioVascular and Thoracic Surgery, August 1, 2008; 7(4): 727 - 729. [Abstract] [Full Text] [PDF]

This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): George Economopoulos Permission Requests Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Economopoulos, G. Search for Related Content PubMed PubMed Citation Articles by Economopoulos, G. Related Collections Valve disease