Pseudo-anévrisme du trigone mitro-aortique : cas clinique et revue de littérature

Vojacek J., Zacek P., Ondrasek J.

Invasive double valve endocarditis (aortic and mitral) involving the fibrous skeleton of the heart requires complex high-risk surgical management. The procedure which was originally suggested by Tirone David, consists of double valve replacement with pericardial or Dacron patches to re-create “neoaortomitral continuity” (1). This operation was named by the Cleveland Clinic group a “Commando procedure”, the Leipzig group use the term “UFO procedure” (2). In patients in whom the posterior mitral leaflet is not affected by the infection and at least the free edge of anterior mitral could be spared, a modification of the Commando procedure was suggested and named the “Hemi-Commando procedure” (3).

Năstase O., Rădulescu B., Şerban M., Lăcău I.S., Bubenek Ş., Popescu B.A., Ginghinã C., Jurcuţ R.

Sudhakar S., Sewani A., Agrawal M., Uretsky B.F.

Pseudoaneurysm in the region of the fibrous body between the mitral and aortic valve, the mitral-aortic intervalvular fibrosa (MAIVF), is a rare complication. The authors provide a comprehensive review of all relevant English-language articles published from 1966 to December 2009. Pseudoaneurysm of the MAIVF was identified in 88 patients in the medical literature and one from the authors' institution (total reported cases, 89). Endocarditis and aortic valve surgery were the most frequently associated causative factors. Symptoms and signs of infection, chest pain, heart failure or shortness of breath, and cerebrovascular accidents accounted for 77% of clinical presentations. The formation of a fistulous tract, coronary artery compression, and death were important described complications. Patients with ring abscesses in the MAIVF region and those with prosthetic aortic valves and histories of endocarditis are at higher risk for developing pseudoaneurysm of the MAIVF. Transesophageal echocardiography was able to identify all cases in which it was used. Surgical correction is the treatment of choice.

Almeida J., Pinho P., Torres J.P., Garcia J.M., Maciel M.J., Lima C.A., Bastos P.T., Gomes M.R.

In the current study we describe the cases of 2 patients operated on for left-sided endocarditis, who later had myocardial ischemia develop secondary to left coronary artery compression from a pseudoaneurysm of the mitral-aortic fibrosa. Because the symptoms of angina persisted despite medical treatment, both patients had second surgeries. Myocardial revascularization was performed in 1 patient; the other patient, who had a severely depressed ventricular function, was given an orthotopic cardiac transplant.