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      Unusual Presentation of Congenital Pseudoaneurysm of Mitral Aortic Intervalvular Fibrosa in a Healthy Child

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          Graphical abstract

          Highlights

          • •

            PA-MAIVF is a rare condition that is usually asymptomatic.

          • •

            Symptoms related to PA-MAIVF generally represent complications.

          • •

            Early identification of this entity is crucial to guide acute management strategies.

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          Neurological complications of infective endocarditis: risk factors, outcome, and impact of cardiac surgery: a multicenter observational study.

          J Reguera, M Noureddine, Juan-Manuel Galvez … (2013)
          The purpose of this study was to assess the incidence of neurological complications in patients with infective endocarditis, the risk factors for their development, their influence on the clinical outcome, and the impact of cardiac surgery. This was a retrospective analysis of prospectively collected data on a multicenter cohort of 1345 consecutive episodes of left-sided infective endocarditis from 8 centers in Spain. Cox regression models were developed to analyze variables predictive of neurological complications and associated mortality. Three hundred forty patients (25%) experienced such complications: 192 patients (14%) had ischemic events, 86 (6%) had encephalopathy/meningitis, 60 (4%) had hemorrhages, and 2 (1%) had brain abscesses. Independent risk factors associated with all neurological complications were vegetation size ≥3 cm (hazard ratio [HR] 1.91), Staphylococcus aureus as a cause (HR 2.47), mitral valve involvement (HR 1.29), and anticoagulant therapy (HR 1.31). This last variable was particularly related to a greater incidence of hemorrhagic events (HR 2.71). Overall mortality was 30%, and neurological complications had a negative impact on outcome (45% of deaths versus 24% in patients without these complications; P<0.01), although only moderate to severe ischemic stroke (HR 1.63) and brain hemorrhage (HR 1.73) were significantly associated with a poorer prognosis. Antimicrobial treatment reduced (by 33% to 75%) the risk of neurological complications. In patients with hemorrhage, mortality was higher when surgery was performed within 4 weeks of the hemorrhagic event (75% versus 40% in later surgery). Moderate to severe ischemic stroke and brain hemorrhage were found to have a significant negative impact on the outcome of infective endocarditis. Early appropriate antimicrobial treatment is critical, and transitory discontinuation of anticoagulant therapy should be considered.
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            Sinus of valsalva aneurysms: review of the literature and an update on management.

            Michael Weinreich, Pey-Jen Yu, Biana Trost (2015)
            Sinus of Valsalva aneurysm (SOVA), a congenital or acquired cardiac defect that is present in roughly 0.09% of the general population, often presents as an incidental finding during cardiac imaging. Although an echocardiogram is the standard imaging technique for such findings, cardiac computed tomography angiography (CCTA) has been increasingly utilized. If SOVA is diagnosed, CCTA is also a useful test for patients who are at low to intermediate risk for coronary artery disease (CAD) prior to surgical repair. CCTA can accurately rule out CAD, obviating the need for invasive angiography in most cases, which may be more risky in SOVA patients because their coronaries may be more difficult to engage and their aortic root may be more prone to injury. Although surgery has previously been the treatment of choice, transcatheter techniques have added to the spectrum of nonsurgical alternatives for repair. We report here 4 incidental SOVA cases and review the current literature.
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              Pseudoaneurysm of the mitral-aortic intervalvular fibrosa (MAIVF): A comprehensive review.

              Digumarthi Sudhakar, Barry Uretsky, Asif Sewani … (2010)
              Pseudoaneurysm in the region of the fibrous body between the mitral and aortic valve, the mitral-aortic intervalvular fibrosa (MAIVF), is a rare complication. The authors provide a comprehensive review of all relevant English-language articles published from 1966 to December 2009. Pseudoaneurysm of the MAIVF was identified in 88 patients in the medical literature and one from the authors' institution (total reported cases, 89). Endocarditis and aortic valve surgery were the most frequently associated causative factors. Symptoms and signs of infection, chest pain, heart failure or shortness of breath, and cerebrovascular accidents accounted for 77% of clinical presentations. The formation of a fistulous tract, coronary artery compression, and death were important described complications. Patients with ring abscesses in the MAIVF region and those with prosthetic aortic valves and histories of endocarditis are at higher risk for developing pseudoaneurysm of the MAIVF. Transesophageal echocardiography was able to identify all cases in which it was used. Surgical correction is the treatment of choice. Copyright © 2010 American Society of Echocardiography. Published by Mosby, Inc. All rights reserved.
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                Author and article information

                Journal
                Journal ID (nlm-ta): CASE (Phila)
                Journal ID (iso-abbrev): CASE (Phila)
                Title: CASE : Cardiovascular Imaging Case Reports
                Publisher: Elsevier
                ISSN (Electronic): 2468-6441
                Publication date PMC-release: 09 May 2018
                Publication date Collection: October 2018
                Publication date (Electronic): 09 May 2018
                Volume: 2
                Issue: 5
                Pages: 231-233
                Affiliations
                [a ]Division of Cardiology, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
                [b ]Division of Cardiovascular Surgery, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
                Article
                Publisher ID: S2468-6441(17)30264-5
                DOI: 10.1016/j.case.2018.02.006
                PMC ID: 6200711
                SO-VID: 276d8425-b05b-493a-90b5-bc314e1c505b
                Copyright © 2018 by the American Society of Echocardiography. Published by Elsevier Inc.
                License:

                This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

                History
                Categories
                Subject: Perplexing Pediatric Case

                Keywords: congenital,pseudoaneurysm,aortic valve
                Data availability:
                Keywords: congenital, pseudoaneurysm, aortic valve

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