Pseudoaneurysms of the mitral-aortic intervalvular fibrosa: Survival without reoperation

Background The tissue spanning the mitral and aortic valves, the mitral-aortic intervalvular fibrosa (MAIVF), may be the site of pseudoaneurysm formation in the setting of infective endocarditis or congenital heart disease, or after valve surgery. Because of potential complications of MAIVF pseudoaneurysms, patients with such lesions are often referred for surgical repair. Methods We identified 3 individuals with MAIVF pseudoaneurysms who were followed without surgical intervention after diagnosis of the MAIVF pseudoaneurysm. The courses of these patients are presented below. Results The MAIVF pseudoaneurysms were measured to be stable in size over several years among 3 patients. Dimensions were 5.3 × 2.3, 7.6 × 4.9, and 4.8 × 2.5 cm. Surgical repair was considered too high a risk in 2 of the individuals, and the third individual refused a third surgical intervention. Of the 3 patients, 2 remain asymptomatic. The third patient was 87 years old when her MAIVF pseudoaneurysm was diagnosed, and she died of noncardiac causes at age 92 years. Conclusions Clinical surveillance and serial imaging of MIAVF pseudoaneurysms may be considered an alternative to surgical management in select individuals.