CASE
An 86-year-old man with a history of mitral valve replacement (MVR) for infective endocarditis 17 years ago and re-do MVR for prosthetic valve endocarditis four years ago presented with fever and shortness of breath. The blood cultures were positive for Enterococcus spp, and antibiotic therapy was initiated. The computed tomography imaging showed the pseudoaneurysm formed at the posterior wall of the left ventricular (Figure 1). Transthoracic echocardiography exhibited the partially detached prosthetic valve from the mitral annulus with severe para-valvular leakage (Figure 2). The patient underwent third-time MVR closing the orifice of LVPA with the Hemashield patch (Figure 3, 4). The 1-year follow-up echocardiography showed no mitral regurgitation or blood flow into the aneurysm.
Left ventricular pseudoaneurysms (LVPA) due to mitral valve infective endocarditis are rare, accounting for less than 1% of all LVPA, and are fatal with a 35-40% risk of rupture [1]. LVPA is formed when an abscess invades the left ventricular myocardium forming an abscess cavity and predisposing to left ventricular wall dissection [2]. In this case, the patient underwent MVR twice, which may have weakened the tissue around the mitral annulus and predisposed to abscess extension into the left ventricular myocardium, leading to the LVPA formation.