ABSTRACT
INTRODUCTION: The mitral-aortic intervalvular fibrosa (MAIVF) has a vital role in the integrity of the mitral and aortic valves. Pseudoaneurysm of the MAIVF (P-MAIVF) usually ensues as a complication of aortic valve surgery, and endocarditis can itself result in several catastrophic complications. CASE PRESENTATION: A 54-year-old male with acute dyspnea was admitted to our hospital. Upon physical and cardiac examination, low blood pressure, low O2 saturation, tachycardia, and a muffled heart were observed. Findings from the transthoracic echocardiography (TTE) were normal besides a massive pericardial effusion with clot formation in the pericardial space, and a pulsatile echo-free space at the posterior aspect of the aortic prosthesis. Accordingly, transesophageal echocardiography (TEE) was performed and confirmed the presence of a P-MAIVF that was rupturing into the pericardial space, causing cardiac tamponade. The patient presented with an unstable hemodynamic situation. A cardiac surgical operation was planned, however, cardiac arrest occurred at the time of induction. The operation was unsuccessful, and the patient expired in the operating room. CONCLUSIONS: Awareness of P-MAIVF formation after cardiac surgery, particularly after aortic valve replacement (AVR) due to an infected bicuspid aortic valve, is vital in order to prevent the occurrence of cardiac tamponade, a fatal event following this phenomenon. TEE is a modality of choice for identifying P-MAIVF in selected patients.