Thirty-three years follow-up of pseudoaneurysm of the mitral-aortic intervalvular fibrosa without surgical treatment: case report and literature review

Abstract

Background The pseudoaneurysm of the mitral-aortic intervalvular fibrosa (PMAIF) is a rare complication of endocarditis or aortic valve surgery. Surgical treatment is often suggested, but the possibility of conservative management remains unclear. Case presentation The 33-year follow-up of a PMAIF that developed six years after aortic valve replacement (AVR) is reported. Initially, the patient began experiencing worsening dyspnea, and echocardiography revealed an ejection fraction (EF) of 20% with a PMAIF measuring 7 × 10 mm. Despite being advised to undergo surgery, the patient declined due to fear of high-risk surgical outcomes. Consequently, conservative treatment with close observation but without surgery was initiated. During the 33-year follow-up period, the patient did not exhibit any adverse health effects. Conclusion The surgery is not necessary for asymptomatic patients with PMAIF, even in cases of sizable pseudoaneurysms, as long as there are no additional local complications or rapid growth. The conservative and non-surgical approach is particularly applicable to patients with a high risk for surgery, for whom regular clinical and echocardiographic monitoring appears to be safe for handling this condition.