Cardiac Tamponade as a Very Rare Complication of Pseudoaneurysm of Mitral Aortic Intervalvular Fibrosa: A Case Report

  • Fereshteh Ghaderi Fellowship of Echocardiography, Atherosclerosis Prevention Research Center, School of medicine, Mashhad University of Medical Sciences, Mashhad, Iran
  • Hamid Hosseinikhah Eepartment of Cardiac Surgery, Imam Reza Hospital, Mashhad University of Medical Sciences, Mashhad, Iran
  • Pouya Nezafati Department of Cardiac Surgery, Ghaem Hospital, Mashhad University of Medical Sciences, Mashhad, Iran


Introduction: The mitral-aortic intervalvular fibrosa (MAIVF) has a vital role in the integrity of the mitral and aortic valves. Pseudoaneurysm of the MAIVF (P-MAIVF) usually ensues as a complication of aortic valve surgery, and endocarditis can itself result in several catastrophic complications.

Case Presentation: A 54-year-old male with acute dyspnea was admitted to our hospital. Upon physical and cardiac examination, low blood pressure, low O2 saturation, tachycardia, and a muffled heart were observed. Findings from the transthoracic echocardiography (TTE) were normal besides a massive pericardial effusion with clot formation in the pericardial space, and a pulsatile echo-free space at the posterior aspect of the aortic prosthesis. Accordingly, transesophageal echocardiography (TEE) was performed and confirmed the presence of a P-MAIVF that was rupturing into the pericardial space, causing cardiac tamponade. The patient presented with an unstable hemodynamic situation. A cardiac surgical operation was planned, however, cardiac arrest occurred at the time of induction. The operation was unsuccessful, and the patient expired in the operating room.

Conclusions: Awareness of P-MAIVF formation after cardiac surgery, particularly after aortic valve replacement (AVR) due to an infected bicuspid aortic valve, is vital in order to prevent the occurrence of cardiac tamponade, a fatal event following this phenomenon. TEE is a modality of choice for identifying P-MAIVF in selected patients.


Afridi I, Apostolidou MA, Saad RM, et al. 1995. Pseudoaneurysms of the mitral-aortic intervalvular fibrosa: dynamic characterization using transesophageal echocardiographic and Doppler techniques. J Am Coll Cardiol 25:137-45.

Agirbasli M, Fadel B. 1999. Mpseudoaneurysm of the Mitral-Aortic Intervalvular Fibrosa: A Long-Term Complication of Infective Endocarditis.Echocardiography 16:253-57.

Bonou M, Papadimitraki ED, Vaina S, et al. 2015. Mitral-Aortic Intervalvular Fibrosa Pseudoaneurysm. J Cardiovasc Ultrasound 23:257-61.

Caselli S, Mazzesi G, Tritapepe L, et al. 2011. 3D echocardiographic delineation of mitral-aortic intervalular fibrosa pseudoaneurysm caused by bicuspid aortic valve endocarditis. Echocardiography 28:E1-4.

David TE, Feindel CM, Armstrong S, et al. 1995. Reconstruction of the mitral annulus: A 10 year experience. J Thorac Cardiovasc Surg 110:1323-32.

Ekici F, Kocabaş A, Aktaş D, et al. 2014. Native aortic valve endocarditis complicated by pseudoaneurysm of mitral-aortic intervalvular fibrosa. Echocardiography 31:E60-3.

Harish A, Hatibu S, Ramkumar SR, et al. 2009. Aneurysm of mitral aortic intervalvular fibrosa- a case report and review. Indian Heart J 61:394-6.

Kahveci G, Yilmaz F, Mutlu B. 2008. Bicuspid aortic valve endocarditis complicated with aortic valve aneurysm and pseudoaneurysm of the mitral-aortic intervalvular fibrosa. Echocardiography 25:799-801.

Kassim TA, Lowery RC, Nasur A, et al. 2010. Pseudoaneurysm of mitral-aortic intervalvular fibrosa: two case reports and review of literature. Eur J Echocardiogr 11:E7.

Lima B, Chamogeorgakis T, MacHannaford JC, et al. 2016. How to do it: The commando operation for reconstruction of the fibrous skeleton with double valve replacement. Heart Surg Forum 19:E308-10

Lin A, Poppas A, Mansoor A, et al. 2015. Pseudoaneurysm of the mitral-aortic intervalvular fibrosa. J Cardiovasc Med (Hagerstown) 16 Suppl 1:S33-4.

Rodrigues-Borges AG, Suresh K, Mirza H, et al. 2002. False aneurysm of the mitral-aortic intervalvular fibrosa after uncomplicated aortic valve replacement. J Am Soc Echocardiogr 15:743-5.

Sadat K, Joshi D, Sudhakar S, et al. 2012. Incremental role of three-dimensional transesophageal echocardiography in the assessment of mitral-aortic intervalvular fibrosa abscess. Echocardiography 29:742.

Sudhakar S, Sewani A, Agrawal M, et al. 2010. Pseudoaneurysm of the mitral-aortic intervalvular fibrosa (MAIVF): A comprehensive review. J Am Soc Echocardiogr 23:1009-18.

Xie M, Li Y, Cheng TO, et al. 2013. Pseudoaneurysm of the mitral-aortic intervalvular fibrosa. Int J Cardiol 166:2-7.