Thrombosis of the left internal mammary artery graft causing acute coronary syndrome after 4 years of coronary bypass surgery

was fistulized from the area near the mitral valve toward the left atrium. Mobile fibrillary vegetations were observed inside the aneurysm. Using the 3-D assessment, a segment bulging towards the mitral valve in diastole was also observed. There was no detectable structural defect of the anterior mitral valve leaflet (Fig. 3a-c; Video 3). Blood cultures were positive for Streptococcus spp. The patient subsequently underwent surgical intervention together with antibiotic therapy. MAIVF pseudoaneurysm from the left atrium to aortic root was restored using bovine pericardium, and aortic valve replacement was also performed (Fig. 4a, b; Video 4).