Fistulized Pseudoaneurysm of the Mitral-Aortic Intervalvular Fibrosa in a Patient after Coronary Artery Bypass Graft Surgery

Pseudoaneurysm is a rare condition in the region of the fibrous body between the mitral and aortic valve, the mitral-aortic intervalvular fibrosa (MAIVF), that has been reported as a sequela of endocarditis and surgical trauma. MAIVF rarely occurs on native aortic valve after infective endocarditis (IE). It is often fatal because of its rapid progress, high rates of rupture and recurrence, and worsening effects on the systemic condition. Echocardiography, especially transesophageal echocardiography, plays an important role in the diagnosis and assessment of this condition. This paper reports a rare case following coronary artery bypass graft surgery. This unusual case of ruptured pseudoaneurysm of MAIVF was caused by infective endocarditis. The pseudoaneurysm ruptured into the LVOT in addition to the left atrium. The transesophageal echocardiography provided precise pieces of information concerning the anatomical detail of the pseudoaneurysm, which is crucial for surgical repair.