European Journal of Echocardiography Advance Access published online on July 23, 2008
European Journal of Echocardiography, doi:10.1093/ejechocard/jen205
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Inter-valvular fibrosa pseudo-aneurysm as a late complication after aortic valve surgery
1 Department of Cardiology, OPD 3, Royal Infirmary of Edinburgh, Little France, Edinburgh EH16 4SA, UK
2 Borders General Hospital, Melrose, Roxburghshire TD6 9BS, UK
Received 14 May 2008; accepted after revision 5 July 2008.
* Corresponding author. Tel: + 44 131 536 1000; fax: + 44 131 242 1920. E-mail address: dana.dawson{at}doctors.org.uk
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We describe the incidental finding of an inter-valvular fibrosa pseudo-aneurysm in the absence of infective endocarditis 12 years after a re-do operation for aortic valve replacement in a patient whose initial pathology was bicuspid aortic valve stenosis.
Keywords: Aortic pseudo-aneurysm; False aneurysm; Aortic valve replacement
A 56-year-old man underwent aortic valve replacement for bicuspid aortic valve stenosis in 1981 with a Carpentier–Edwards bio-prosthesis. He had a re-do operation in 1993 with a Bjork–Shiley prosthesis. Regular follow-up was uneventful, with normal imaging in the past 2 years. Recently, he was admitted for an elective urological operation. Post-surgery, he became pyrexial and although there were no clinical or laboratory findings consistent with infective endocarditis, there was enough concern owing to the mechanical prosthesis to request a transthoracic echocardiogram.
This showed a thin structure prolapsing from the aortic root into the left atrium, expanding in systole and collapsing in diastole (Figure 1, Movie 1). Trans-oesophageal examination established the diagnosis of a 5 x 3 cm echo-lucent cavity with flow within between the mitral and aortic annuli (Figure 2, Movie 2) and demonstrated its disappearance after closure and patching with bovine pericardium.
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False aneurysms of the aorta are a rare complication after aortic valve and/or aortic root surgery. The most proximal site of formation of such pseudo-aneurysms is the mitral-aortic fibrous continuity; these are named inter-valvular fibrosa pseudo-aneurysms. They usually occur as a result of aortic prosthesis endocarditis,1 although early post-operative pseudo-aneurysm formation has been described in the absence of infection.2 Such a late presentation, 12 years post-surgery, has not been reported. We propose that suboptimal tissue quality associated with a spectrum of diseases involving the aortic valve/aortic wall and multiple surgical interventions may have been the predisposing factors for the inter-valvular fibrosa pseudo-aneurysm formation in the absence of infection.
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- 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) 25:137–45.[Abstract]
- Rodrigues Borges AG, Suresh K, Mirza H, Katz JP, Simandl SL, Bilfinger T, et al. False aneurysm of the mitral-aortic intervalvular fibrosa after uncomplicated aortic valve replacement. J Am Soc Echocardiogr (2002) 15:743–5.[CrossRef][Web of Science][Medline]
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