CTICasesProsthetic Aortic Valve Pseudoaneurysms from Infective Endocarditis
Imaging findings
CT demonstrates two large pseudoaneurysms adjacent to the aortic root in a patient with prosthetic aortic valve endocarditis from IV drug abuse. The pseudoaneurysms are located periannularly, arising from infection at or near the aortic root, with one involving the mitral-aortic intervalvular fibrous curtain between the left ventricular outflow tract and the left atrium. The pseudoaneurysms are contrast-filled cavities communicating with the native aortic root structures, and their locations are shown on multiple imaging planes including axial and sagittal reformats.
Key takeaways
Periannular pseudoaneurysms complicating prosthetic aortic valve endocarditis represent a severe and life-threatening complication requiring urgent surgical repair. The mitral-aortic intervalvular fibrous curtain (aortic-mitral curtain) is a relatively avascular fibrous area between the aortic and mitral valves that is particularly susceptible to pseudoaneurysm formation because of its limited vascular supply. CT is the imaging modality of choice for identifying and characterizing these pseudoaneurysms, and sagittal reformats are helpful in demonstrating the relationship to cardiac structures. Surgical repair requires replacement of both the pseudoaneurysm-bearing root and the valve.
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