HomeCirculationVol. 96, No. 9Pseudoaneurysm in the Intervalvular Mitral-Aortic Region After Endocarditis and Prosthetic Aortic Valve Replacement Free AccessResearch ArticleDownload EPUBAboutView EPUBSections ToolsAdd to favoritesDownload citationsTrack citationsPermissions ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toFree AccessResearch ArticleDownload EPUBPseudoaneurysm in the Intervalvular Mitral-Aortic Region After Endocarditis and Prosthetic Aortic Valve Replacement Gerhard Pongratz, Magdalena Pohlmann, Gisbert Gehling and Kurt Bachmann Gerhard PongratzGerhard Pongratz From the Department of Internal Medicine, Division of Cardiology, University of Erlangen-Nuremberg, Germany. , Magdalena PohlmannMagdalena Pohlmann From the Department of Internal Medicine, Division of Cardiology, University of Erlangen-Nuremberg, Germany. , Gisbert GehlingGisbert Gehling From the Department of Internal Medicine, Division of Cardiology, University of Erlangen-Nuremberg, Germany. and Kurt BachmannKurt Bachmann From the Department of Internal Medicine, Division of Cardiology, University of Erlangen-Nuremberg, Germany. Originally published4 Nov 1997https://doi.org/10.1161/01.CIR.96.9.3241Circulation. 1997;96:3241–3242A 50-year-old man was referred for transesophageal echocardiography. The patient had undergone a prosthetic aortic valve replacement (Medtronic Hall A 23) 5 months previously because of severe aortic regurgitation due to staphylococcal endocarditis. The postoperative course was complicated by a fever that lasted 3 months. Actually, the multiplane transesophageal echocardiography examination revealed an echo-free pouch located posteriorly, in the mitral aortic intervalvular region that was bounded by the base of the anterior mitral leaflet, the posterior aortic root, and the medial wall of the left atrium. A marked pulsatility was detected, with the cavitary lesion expanding in early systole and collapsing in diastole (Figure, top). The maximal cavity area was 3.35 cm2, and the minimal area was 1.85 cm2. The cavitary pouch opened to the left ventricular outflow tract through a fistulous dehiscence in the mitral-aortic continuity as shown by color-flow Doppler imaging (Figure, bottom). No signs indicating a rupture of the lesion to the aorta or the left atrium were found. The characteristic pulsatile dynamic of the lesion during the cardiac cycle and the communication with the left ventricular outflow tract are criteria diagnostic of a pseudoaneurysm of the mitral-aortic intervalvular fibrosa.The editor of Images in Cardiovascular Medicine is Hugh A. McAllister, Jr, MD, Chief, Department of Pathology, St Luke's Episcopal Hospital and Texas Heart Institute, and Clinical Professor of Pathology, University of Texas Medical School and Baylor College of Medicine.Circulation encourages readers to submit cardiovascular images to Dr Hugh A. McAllister, Jr, St Luke's Episcopal Hospital and Texas Heart Institute, 6720 Bertner, MC1-267, Houston, TX 77030.Download figureDownload PowerPoint Figure 1. Transesophageal echocardiogram shows longitudinal views of the intervalvular pseudoaneurysm. LA indicates left atrium; LVOT, left ventricular outflow tract. Top, Marked pulsatility of cavitary lesion during heart cycle is demonstrated in systole and in diastole. Bottom, Fistulous flow between pseudoaneurysm and LVOT is demonstrated by color Doppler.FootnotesCorrespondence to Gerhard Pongratz, MD, Department of Internal Medicine, Division of Cardiology, University of Erlangen-Nuremberg, Östliche Stadtmauerstr 29, D-91054 Erlangen, Germany. Previous Back to top Next FiguresReferencesRelatedDetailsCited By Hayley B and Leung Chan K (2016) Infectious Complications in Infective Endocarditis Infective Endocarditis, 10.1007/978-3-319-32432-6_10, (123-136), . Şahan E, Gül M, Şahan S, Sokmen E, Guray Y and Tufekçioglu O (2014) Pseudoaneurysm of the mitral–aortic intervalvular fibrosaPseudoaneurysma der mitral-aortalen intervalvulären Fibrosa, Herz, 10.1007/s00059-014-4185-z, 40:S2, (182-189), Online publication date: 1-Apr-2015. Xie M, Li Y, Cheng T, Wang X, Lu Q, He L and Fu M (2013) Pseudoaneurysm of the mitral-aortic intervalvular fibrosa, International Journal of Cardiology, 10.1016/j.ijcard.2012.03.004, 166:1, (2-7), Online publication date: 1-Jun-2013. Baydar O, Coşkun U, Balaban B, Cetin G, Firatli I, Ersanli M and Kucukoglu M (2013) Cardiac Tamponade due to Left Ventricular Pseudoaneurysm After Aortic Valve Replacement, The Heart Surgery Forum, 10.1532/HSF98.20121083, 16:1, (49) Sudhakar S, Sewani A, Agrawal M and Uretsky B (2010) Pseudoaneurysm of the Mitral-Aortic Intervalvular Fibrosa (MAIVF): A Comprehensive Review, Journal of the American Society of Echocardiography, 10.1016/j.echo.2010.07.015, 23:10, (1009-1018), Online publication date: 1-Oct-2010. Kassim T, Lowery R, Nasur A, Corrielus S, Weissman G, Sears-Rogan P, Greenberg M and Singh S (2009) Pseudoaneurysm of mitral–aortic intervalvular fibrosa: two case reports and review of literature, European Heart Journal - Cardiovascular Imaging, 10.1093/ejechocard/jep189, 11:3, (E7-E7), Online publication date: 1-Apr-2010., Online publication date: 1-Apr-2010. Da Col U, Ramoni E, Di Bella I and Ragni T (2008) An Unusual Left Ventricular Outflow Pseudoaneurysm: Usefulness of Echocardiography and Multidetector Computed Tomography for Surgical Repair, CardioVascular and Interventional Radiology, 10.1007/s00270-008-9406-5, 32:1, (188-191), Online publication date: 1-Jan-2009. Garneau S, Demers P and Denault A (2007) Unexpected Periaortic Cavity During Heart Surgery, Anesthesia & Analgesia, 10.1213/01.ane.0000247701.02087.c6, 104:1, (75-76), Online publication date: 1-Jan-2007. Ghersin E, Litmanovich D, Agmon Y and Milo S (2005) Pseudoaneurysm of the mitral-aortic intervalvular fibrosa following aortic valve replacement – diagnosis and dynamic evaluation with multidetector CT and transesophageal echocardiography, Interactive CardioVascular and Thoracic Surgery, 10.1510/icvts.2005.112607, 4:6, (502-504), Online publication date: 1-Dec-2005., Online publication date: 1-Dec-2005. November 4, 1997Vol 96, Issue 9 Advertisement Article InformationMetrics Copyright © 1997 by American Heart Associationhttps://doi.org/10.1161/01.CIR.96.9.3241 Originally publishedNovember 4, 1997 Advertisement

Several provocation maneuvers are described in hypertrophic cardiomyopathy to Doppler echocardiographically distinguish the obstructive from the non obstructive type. No data are available about the value of orthostasis testing in comparison with nitrate application in this disease. In this study, 16 consecutive patients with hypertrophic cardiomyopathy were examined. 11 patients with hypertrophic cardiomyopathy were classified as obstructive, 5 patients with hypertrophic cardiomyopathy as non obstructive. Normal left ventricular outflow tract velocities as detected by the Doppler method were defined as < 2,0 m/s.

In 63 St. Jude bileaflet and 34 Bjoerk-Shiley tilting disk aortic valve prostheses, Doppler continuity areas were compared to their corresponding geometric areas defined by the opening angle of the occluders. Continuity areas correlated significantly with geometric areas in Bjoerk-Shiley (p = 0.68) and St. Jude prostheses (p = 0.86). Differences between continuity and geometric areas were greater in St. Jude than in Bjoerk-Shiley valves (0.87 +/- 0.45 cm2 vs. 0.06 +/- 0.47 cm2, p < 0.0001). Exclusion of patients with atrial fibrillation, with a postoperative interval of less than 1 year or valve sizes of 19 and 21 mm did not change the results. Thus, underestimation of geometric areas is present in the St. Jude bileaflet aortic valves, while geometric and continuity areas are not significantly different in Bjoerk-Shiley prostheses. These results are attributable to the effect of valve-type-dependent velocity profiles.

Article Belastungs-Magnetokardiographie (E-MKG): klinische Anwendung der Stromdichterekonstruktion bei myokardialen Ischämien. was published on January 1, 1993 in the journal Biomedical Engineering / Biomedizinische Technik (volume 38, issue s1).