CTICasesMitral-Aortic Intervalvular Fibrosa Pseudoaneurysm Post-Mitral Valve Replacement
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Imaging findings
Cardiac MRI in a patient with a bioprosthetic mitral valve reveals a cystic structure, initially thought to be associated with the right atrium, but found to originate from the left ventricular side near the mitral valve. Cine images demonstrate turbulent flow jets entering this structure during systole, causing it to expand, and then contracting during diastole, indicating to-and-fro flow. This appearance is characteristic of a pseudoaneurysm located at the mitral-aortic intervalvular fibrosa.
Key takeaways
Pseudoaneurysms can occur at the mitral-aortic intervalvular fibrosa following mitral or aortic valve replacement, as this is a relatively avascular fibrous plane susceptible to injury. They can be subtle and easily overlooked, requiring careful evaluation with cardiac MRI, especially cine sequences to assess flow dynamics. Endocarditis (even subclinical) or sterile dehiscence are potential etiologies.
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