CASE
An 86-year-old man with a history of mitral valve replacement (MVR) for
infective endocarditis 17 years ago and re-do MVR for prosthetic valve
endocarditis four years ago presented with fever and shortness of
breath. The blood cultures were positive for Enterococcus spp, and
antibiotic therapy was initiated. The computed tomography imaging showed
the pseudoaneurysm formed at the posterior wall of the left ventricular
(Figure 1). Transthoracic echocardiography exhibited the partially
detached prosthetic valve from the mitral annulus with severe
para-valvular leakage (Figure 2). The patient underwent third-time MVR
closing the orifice of LVPA with the Hemashield patch (Figure 3, 4). The
1-year follow-up echocardiography showed no mitral regurgitation or
blood flow into the aneurysm.
Left ventricular pseudoaneurysms (LVPA) due to mitral valve infective
endocarditis are rare, accounting for less than 1% of all LVPA, and are
fatal with a 35-40% risk of rupture [1]. LVPA is formed when an
abscess invades the left ventricular myocardium forming an abscess
cavity and predisposing to left ventricular wall dissection [2]. In
this case, the patient underwent MVR twice, which may have weakened the
tissue around the mitral annulus and predisposed to abscess extension
into the left ventricular myocardium, leading to the LVPA formation.