Methodist Journal

IN THIS ISSUE

Venous Interventions

Vol 14, Issue 3 (2018)


FEATURED GUEST EDITOR

ISSUE INTRO

It’s Time We Reassess Our Primitive Understanding of the Venous System

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RECOGNITIONS

Jean Bismuth Spearheads Issue on Venous Interventions

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REVIEW ARTICLES See More

Central Venous Pathologies: Treatments and Economic Impact

Venous Thrombosis and Post-Thrombotic Syndrome: From Novel Biomarkers to Biology

Mechanical Properties of Diseased Veins

Use of Computed Tomography and Magnetic Resonance Imaging in Central Venous Disease

Application of Intravascular Ultrasound in End-Stage Renal Patients with Central Venous Occlusive Disease

Intraoperative Imaging and Image Fusion for Venous Interventions

Endovascular Treatment for Venous Diseases: Where are the Venous Stents?

Endovascular Therapy for Central Venous Thrombosis

CASE REPORTS See More

Immune Checkpoint Inhibitor Related Cardiotoxicity

Tyrosine Kinase Inhibitor-Induced Acute Myocarditis, Myositis, and Cardiogenic Shock

Primary Nonbacterial Thrombotic Endocarditis Presenting with Bowel Infarction Secondary to Superior Mesenteric Artery Embolism

Persistent Left Superior Vena Cava with Absent Right Superior Vena Cava

MUSEUM OF HMH MULTIMODALITY IMAGING CENTER See More

Incision and Drainage of a Forgotten Vascular Graft

CLINICAL PERSPECTIVES See More

EXCERPTA

Telemedicine Shakes Up the ICU Experience

POINTS TO REMEMBER

Venous Thrombosis in Nephrotic Syndrome

EXCERPTA

Heartsick: Medical and Ethical Challenges of Infective Endocarditis in the Opioid Epidemic

EXCERPTA

Redefining “Worth It” for CTO PCI

EDITORIALS

Letter to the Editor

Vol 14, Issue 2 (2018)

Article Full Text

MUSEUM OF HMH MULTIMODALITY IMAGING CENTER

A Case of Infected Mitral-Aortic Intervalvular Fibrosa Pseudoaneurysm

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Article Citation:

Malahfji M, Chamsi-Pasha M, Chang SM. A Case of Infected Mitral-Aortic Intervalvular Fibrosa Pseudoaneurysm. Methodist DeBakey Cardiovasc J. 2018;14(2):151-152.

doi: 10.14797/mdcj-14-2-151

Keywords
intervalvular fibrosa pseudoaneurysm , prosthetic valve infection

An 81-year-old woman presented with fever and shortness of breath. She had an aortic valve replacement in 2012 (a 19-mm St. Jude Trifecta bioprosthetic valve) as well as coronary artery bypass grafting. Blood cultures were positive for vancomycin-intermediate Staphylococcus aureus. Transthoracic echocardiography showed degeneration of the aortic valve prosthesis with severe aortic insufficiency and a tricuspid valve vegetation.

Transesophageal echocardiography demonstrated pseudoaneurysm formation in the mitral-aortic intervalvular fibrosa (MAIVF) (Figures 1, 3). Color Doppler showed systolic and diastolic flow into the pseudoaneurysm (Figure 2). Cardiac computed tomography showed that the ruptured abscess cavity extended from the aortic root to the proximal ascending aorta (Figure 4, red arrow).

The patient underwent debridement of the aortic annulus as well as aortic root and ascending aorta replacement using a CryoLife allograft (CryoLife, Inc.). The tricuspid valve vegetation was removed, and intravenous antibiotic therapy was continued for 8 weeks with daptomycin and ceftaroline followed by lifelong doxycycline therapy. She was discharged to rehabilitation 2 weeks later.

The MAIVF is a fibrous structure located at the junction of the anterior mitral leaflet and the noncoronary cusp of the aortic valve. It is relatively avascular, which makes it prone to infection and injury resulting in pseudoaneurysm formation. When making the diagnosis, it is important to visualize the echo-free space with systolic expansion and diastolic collapse of the pseudoaneurysm.1 Patients with ring abscesses in the MAIVF region, prosthetic aortic valves, or histories of endocarditis are at higher risk for developing pseudoaneurysm of the MAIVF. Transesophageal echocardiography is critical to make the diagnosis.2

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References
  1. Afridi I, Apostolidou MA, Saad RM, Zoghbi WA. Pseudoaneurysms of the mitral-aortic intervalvular fibrosa: dynamic characterization using transesophageal echocardiographic and Doppler techniques. J Am Coll Cardiol 1995 Jan;25(1):137-45.
  2. Sudhakar S, Sewani A, Agrawal M, Uretsky BF. Pseudoaneurysm of the mitral-aortic intervalvular fibrosa (MAIVF): A comprehensive review. J Am Soc Echocardiogr. 2010 Oct;23(10):1009-18.

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