Methodist Journal

IN THIS ISSUE

Cardiovascular Imaging

Vol 16, Issue 2 (2020)


FEATURED GUEST EDITOR

ISSUE INTRO

Cardiovascular Imaging: A Window into Diagnostic and Therapeutic Management

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RECOGNITIONS

Guest Editor Dipan J. Shah Lends Expertise and Insight to Special Issue on Cardiovascular Imaging

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REVIEW ARTICLES See More

Cardiac Computed Tomography for Comprehensive Coronary Assessment: Beyond Diagnosis of Anatomic Stenosis

Cardiac Magnetic Resonance in Nonischemic Cardiomyopathies

Cardiac Computed Tomography for Structural Heart Disease Assessment and Therapeutic Planning: Focus on Prosthetic Valve Dysfunction

Fluorodeoxyglucose Applications in Cardiac PET: Viability, Inflammation, Infection, and Beyond

Cardiac Magnetic Resonance in Valvular Heart Disease: Assessment of Severity and Myocardial Remodeling

Patient-Specific Modeling for Structural Heart Intervention: Role of 3D Printing Today and Tomorrow

Artificial Intelligence in Cardiovascular Imaging

Myocardial Perfusion Imaging Using Positron Emission Tomography

CASE REPORTS See More

COVID-19: A Potential Risk Factor for Acute Pulmonary Embolism

Cardiac Lymphoma Presenting with Recurrent STEMI

Complete Heart Block in Systemic Sclerosis with Characterization on Cardiac MRI

Repair of Extent III Thoracoabdominal Aneurysm in the Presence of Aortoiliac Occlusion

MUSEUM OF HMH MULTIMODALITY IMAGING CENTER See More

A T2-Weighty Discovery: Aortitis on Cardiac MRI with Histopathologic Correlation

CLINICAL PERSPECTIVES See More

POINTS TO REMEMBER

Case-Based Points on the Role of Imaging in Kidney Disease

POINTS TO REMEMBER

Acute Kidney Injury in Cardiogenic Shock

EXCERPTA

Cardio-Oncology, Then and Now: An Interview with Barry Trachtenberg

POINTS TO REMEMBER

Onconephrology: An Evolving Field

EDITORIALS

Letter to the Editor in Response to “Cardiac Autonomic Neuropathy in Diabetes Mellitus”

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

Figure 1.
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Figure 4.
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.