Pseudoaneurysm of the mitral-aortic intervalvular fibrosa and mitral valve perforation as a complication of infective endocarditis: a case report and literature review.

Background: Pseudoaneurysm of the mitral-aortic intervalvular fibrosa (MAIVF) is a rare but serious complication, most commonly associated with infective endocarditis or cardiac surgery. Early detection and appropriate timing of surgical intervention are crucial to prevent life-threatening consequences.

Case summary: We present the case of a 74-year-old man with a recent history of dual-chamber pacemaker implantation who presented with atypical chest pain and low-grade fever. Initial transthoracic echocardiography raised suspicion of mitral valve pathology, but transoesophageal and 3D echocardiography revealed a pseudoaneurysm of the MAIVF and a flail posterior mitral leaflet due to leaflet perforation. Blood cultures confirmed Staphylococcus epidermidis infective endocarditis. The patient underwent urgent valve replacement surgery but unfortunately developed severe biventricular dysfunction and died despite maximal supportive care.

Discussion: This case illustrates the critical role of multimodality imaging, especially 3D echocardiography, in diagnosing MAIVF pseudoaneurysm and assessing surgical indications in the context of infective endocarditis. Surgical timing and haemodynamic stability are essential in optimizing outcomes.