© 2013, Wiley Periodicals, Inc. DOI: 10.1111/echo.12431
Echocardiography
CASE REPORT
Native Aortic Valve Endocarditis Complicated by Pseudoaneurysm of Mitral-Aortic Intervalvular Fibrosa ukan Aktasß, M.D., _Ilker C lu, M.D. Filiz Ekici, M.D., Abdullah Kocabasß, M.D., Dog ß etin, M.D., and Sancar Eminog Department of Pediatric Cardiology, Ankara Children’s Hematology and Oncology Research and Training Hospital, Ankara, Turkey
Pseudoaneurysm of mitral-aortic intervalvular fibrosa (PA-MAIVF) is a rare complication of native aortic valve endocarditis. This region is a relatively avascular area and prone to infection during endocarditis and subsequent aneurysm formation. The rupture into the pericardial cavity and left atrium or aorta, systemic embolism, myocardial infarction secondary to left coronary compression, and sudden death are the reported complications. Herein, we present a 9-year-old boy who was diagnosed with bicuspid aortic valve endocarditis complicated by PA-MAIVF, cerebral embolism, and hemorrhage. PA-MAIVF was visualized by both two- and three-dimensional transthoracic echocardiography and ruptured into pericardial space causing a fatal outcome. (Echocardiography 2013;00:E1–E4) Key words: pseudoaneurysm of mitral-aortic intervalvular fibrosa, bicuspid aortic valve, infective endocarditis
Introduction: Pseudoaneurysm of mitral-aortic intervalvular fibrosa (PA-MAIVF) is a very rare complication of the aortic valve endocarditis.1 Pseudoaneurysm usually occurs as a result of infection, prosthetic valve surgery, chest trauma, and tuberculosis or it may less frequently be congenital in origin.2,3 MAIVF tissue is a relatively avascular area and prone to infection during endocarditis and subsequent aneurysm formation. Wall of aneurysm may rupture into the pericardial cavity, left atrium or aorta and cause systemic embolism or myocardial infarction secondary to left coronary compression.2–5 In the present case report, we present a boy diagnosed with a large PA-MAIVF and bicuspid aortic valve (BAV) endocarditis. Also, the PA-MAIVF was visualized using the real-time three-dimensional transthoracic echocardiography (3D-TTE). Case Report: A 9-year-old Turkish boy who was diagnosed with BAV and a perimembranous ventricular septal defect (VSD) was referred to our hospital for a suspicion of endocarditis. He was previously admitted to another hospital due to high-grade Address for correspondence and reprint requests: Abdullah Kocabasß, M.D., Department of Pediatric Cardiology, Ankara Children’s Hematology and Oncology Research and Training Hospital, Dısßkapı, Ankara, Turkey. Fax: +90-32-347-23-30; E-mail:
[email protected]
fever and abdominal pain 15 days ago. He was evaluated for infectious and vasculitic diseases; however, his diagnostic test results were normal. Then, a broad spectrum antibiotic therapy (ceftriaxone) was initiated because of the fever of unknown origin. However, his fever was persisted and polyarthritis and cutaneous lesions developed as well. On admission, his physical examination revealed fever (38.9°C), poor dental hygiene, sinus tachycardia and a systolic murmur, but no hemodynamic or neurological disturbances. Janeway lesions and splinter hemorrhage were detected at extremities (Fig. 1). In his laboratory results, leucocyte count was 28.600/mm³, hemoglobin level was 10.2 g/dL, serum albumin was 2.5 g/dL, C-reactive protein was 10 mg/dL (normal
