Large unruptured Pseudoaneurysm of Mitral-Aortic Intervalvular Fibrosa-Managed Conservatively for Three Years: Case Report and Review of Literature

Abstract

Here in, we describe a rare case of an eleven years old boy who was diagnosed with infective endocarditis of a congenitally bicuspid aortic valve with severe aortic stenosis, severe aortic regurgitation and complicated by cerebral embolism. He was managed with intravenous antibiotics for 6 weeks. A pre-discharge transthoracic echocardiogram revealed a large, unruptured pseudoaneurysm of the mitral-aortic inter valvular fibrosa that was confirmed by transesophageal echocardiography and cardiac MRI. Patient’s parents initially refused surgery and he was managed conservatively for 3 years. Serial echocardiograms performed during this period
demonstrated progressive dilatation of the left ventricle and aorta, with a small increase in the size of pseudoaneurysm. Patient was subsequently referred for surgery (Aortic valve replacement with reconstruction of mitralaortic intervalvular fibrosa). In conclusion, our case demonstrates that close clinical follow up and periodic imaging may be a reasonable alternative to early surgery in managing patients with uncomplicated pseudoaneurysm of mitral-aortic intervalvular fibrosa.