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Infective Endocarditis with Pseudoaneurysm of the Mitral-Aortic Intervalvular Fibrosa Presenting as Complete Heart Block.

R I Med J (2013)

August 2021

Attending Physician, Rhode Island Hospital; Clinical Associate Professor of Medicine, Alpert Medical School of Brown University, Providence, RI.

A 79-year-old male with a history of ESRD and treated MRSA endocarditis was found to have a recurrence of MRSA bacteremia. He was treated with antibiotics. During his hospitalization, he suddenly developed complete heart block requiring transcutaneous pacing, and subsequently transvenous pacing wires were placed.

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Pseudo-aneurysm of the mitral-aortic intervalvular fibrosa (MAIVF) is a rare complication of native or prosthetic valve endocarditis. Good imaging is the key to successful diagnosis of this rare entity. This report describes a pseudo - aneurysm of the MAIVF rupturing into left atrium in a patient with double valve replacement with special reference to 3-dimensional transesophageal echocardiographic imaging.

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The fibrous body between the mitral and aortic valve, known as mitral-aortic intervalvular fibrosa (MAIVF) is prone to infection and injury resulting in pseudo-aneurysm formation. Because of its relative rarity, we are far from making any conclusion regarding the natural history and appropriate therapeutic strategy for this condition. We report two cases of this condition with two different and rare etiologies with strikingly different natural courses, providing insight into the natural course and timing of surgery in this rare entity.

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Pseudo-aneurysm of the fibrous continuity zone between the aortic and mitral valves, the so-called "mitral-aortic intervalvular fibrosa" is a rare complication of acute infective endocarditis, rarely after an aortic valve replacement. We report the case of a large pseudo-aneurysm occurred in a 70-year-old man, who had a history of surgical aortic valve replacement 3 years before. There were no biological or clinical evidence for infective acute endocarditis.

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