Abstract
Pseudoaneurysm of the mitral–aortic intervalvular fibrosa (P-MAIVF) is an infrequent but potentially life-threatening condition. Both transthoracic echocardiography (TTE) and transesophageal echocardiography (TEE) can detect P-MAIVF with sensitivity rates of 43 and 90 %, respectively. The typical finding of echocardiography is a pulsatile echo-free sac that expands in systole and collapses in diastole. Our review comprises 166 patients with P-MAIVF, including eight cases in our hospital and 158 cases from the literature. P-MAIVF is often associated with infection or surgical trauma. While it is likely to maintain an asymptomatic course, symptoms of shortness of breath, heart failure, valvular disease, chest pain, endocarditis, and cerebrovascular events are common clinical presentations. The recommended treatment is surgery. However, conservative therapy is an alternative approach for high-risk patients or when surgical treatment is refused. With the increasing incidence of cardiac surgery and infective endocarditis, a likely increment in the new diagnosis of pseudoaneurysm is expected.
Zusammenfassung
Das Pseudoaneurysma der mitral-aortalen intervalvulären Fibrosa (MAIVF, aortomitraler Übergang) ist nicht häufig, aber potenziell lebensbedrohlich. Sowohl mit der transthorakalen Echokardiographie (TTE) als auch mit der transösophagealen Echokardiographie (TEE) kann ein Pseudoaneurysma der MAIVF (P-MAIVF) mit einer Sensitivitätsrate von 43 bzw. 90 % diagnostiziert werden. Typischer Befund bei der Echokardiographie ist ein pulsierender echofreier Sack, der sich in der Systole ausdehnt und in der Diastole zusammenfällt. In die Studie wurden 166 Patienten mit P-MAIVF, darunter 8 Fälle aus der Klinik der Autoren und 158 Fälle aus der Literatur, aufgenommen. Oft geht ein P-MAIVF mit einer Infektion oder einem chirurgischen Trauma einher. Es ist zwar wahrscheinlich, dass der Verlauf asymptomatisch ist, aber Symptome wie Luftnot, Herzinsuffizienz, Herzklappenerkrankungen, Schmerzen in der Brust, Endokarditis und zerebrovaskuläre Ereignisse sind häufige klinische Zeichen. Zumeist wird die chirurgische Behandlung empfohlen. Die konservative Therapie ist jedoch ein alternativer Ansatz für Hochrisikopatienten oder in Fällen, in denen die Operation abgelehnt wird. Mit Zunahme der Häufigkeit von Herzoperationen und infektiöser Endokarditis ist auch von einem Anstieg der neuen Diagnose des Pseudoaneurysmas auszugehen.
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Abbreviations
- LVOT:
-
Left ventricular outflow tract
- MAIVF:
-
Mitral–aortic intervalvular fibrosa
- P-MAIVF:
-
Pseudoaneurysm of the mitral–aortic intervalvular fibrosa
- TEE:
-
Transesophageal echocardiography
- TTE:
-
Transthoracic echocardiography
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Conflict of interest. E. Şahan, M. Gül, S. Şahan, E. Sokmen, Y.A. Guray, and O. Tufekçioglu state that there are no conflicts of interest. The accompanying manuscript does not include studies on humans or animals.
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Şahan, E., Gül, M., Şahan, S. et al. Pseudoaneurysm of the mitral–aortic intervalvular fibrosa. Herz 40 (Suppl 2), 182–189 (2015). https://doi.org/10.1007/s00059-014-4185-z
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DOI: https://doi.org/10.1007/s00059-014-4185-z
Keywords
- Pseudoaneurysm
- Mitral–aortic intervalvular fibrosa
- Transthoracic echocardiography
- Transesophageal echocardiography
- Therapy