Pseudoaneurysm of mitral-aortic intervalvular fibrosa: two case reports and review of literature.

The aim of this study was to identify the echocardiographic characteristics of pseudoaneurysm of the mitral-aortic intervalvular fibrosa, which is a rare and life-threatening complication of infective endocarditis. We have demonstrated the difference in clinical presentation and management of acute and chronic types of this pseudoaneurysm, together with a review of literature of the topic. We present two cases, one acute and the other an example of a chronic pseudoaneurysm of the mitral-aortic intervalvular fibrosa. The abscess may enlarge rapidly and rupture, resulting in haemorrhage with a catastrophic outcome. Rarely, the pseudoaneurysm will undergo a subclinical course, thicken and organize into a chronic aneurysm. Transoesophageal echocardiogram demonstrates a false lumen below the aortic valve annulus at the mitral-aortic intervalvular fibrosa with marked pulsatility with systolic expansion and diastolic collapse. The successful management of acute pseudoaneurysm necessitates extensive resection and replacement of the infected areas around the pseudoaneurysm. In chronic pseudoaneurysm, there is structural integrity around the calcified pseudoaneurysm, potentially minimizing the need for an extirpative surgery. Pseudoaneurysm of the mitral-aortic intervalvular fibrosa is a rare complication of infective endocarditis, but delay in diagnosis can lead to devastating outcome.

An unusual case of multiple papillary fibroelastoma, review of literature.

Primary neoplasms of the cardiac valves are extremely rare. However, papillary fibroelastoma is the third most common primary tumor of the heart [Ann Thorac Surg 52 (1991) 1127]. These tumors can be found anywhere in the heart, but most commonly involve the cardiac valves [Ann Thorac Surg 52 (1991) 1127; McAllister HA, Fenoglio JJ. Tumors of the cardiovascular system. In: Atlas of tumor pathology, 2nd series, vols. 1-3. Washington (DC): Armed Forces Institute of Pathology; 1978. p. 20-5]. Most papillary fibroelastomas do not cause symptoms and are usually incidental findings by routine echocardiography or at autopsy. However, early diagnosis of this condition is important, since it represents a surgically correctable cause of systemic emboli, stroke, myocardial infarction, and sudden cardiac death [Ann Thorac Surg 52 (1991) 1127; Ann Thorac Surg 68 (1999) 1881; J Am Soc Echocardiogr 9 (1996) 353; Tex Heart Inst J 22 (1995) 327; Tex Heart Inst J 26 (1999) 298]. The echocardiographic findings should be confirmed by histology, since the clinical differential diagnosis includes myxoma, vegetation, thrombi, lipoma, and pseudopapillary fibroelastoma [Tex Heart Inst J 26 (1999) 298; J Am Soc Echocardiogr 11 (1998) 92; J Natl Med Assoc 87 (1995) 68]. Review of the literature reveals that multiple papillary fibroelastomas are extremely rare [Am Heart J 125 (1993) 1443; J Am Soc Echocardiogr 7 (1994) 315; Ann Thorac Surg 48 (1989) 119]. Li Manduri et al. [J Am Soc Echocardiogr 7 (1994) 315] reported multiple masses on the tricuspid valve, the larger of which was 1 cm in diameter. De Virgilio et al. [Ann Thorac Surg 48 (1989) 119] reported a case of multiple 1-cm papillary fibroelastomas located on mitral valve, left ventricular outflow tract, and along septum. We report an unusual case of multiple papillary fibroelastomas in a woman, who initially was admitted because of a shortness of breath and recent cerebrovascular accident.

Traumatic partial avulsion of a single right subclavian artery from the aortic arch and definitive repair.

Blunt injury to the right subclavian artery is a rare complication of severe deceleration trauma often associated with significant morbidity and mortality. We describe an atypical presentation in a patient who sustained a traumatic avulsion of his right subclavian artery arising off the aortic arch. An interposition graft was used to restore the continuity of the artery to the ascending thoracic aorta.