Ruptured mitral-aortic intervalvular fibrosa aneurysm with flail aortic valve.

1 of 2 DESCRIPTION Rupture of mitral-aortic intervalvular fi brosa aneurysm is a rare complication of aortic valve endocarditis. 1 A 43-yearold man presented with persistent fever and progressive dyspnoea of 3 months duration. On admission, he was in fl orid pulmonary oedema and clinical examination showed fi ndings of severe aortic regurgitation. His electrocardiogram revealed complete heart block with junctional escape rhythm. The echocardiogram showed an aneurysm of mitral-aortic intervalvular fi brosa in parasternal long-axis view ( fi gure 1 and video 1 ). Such aneurysms are recognised echocardiographically as an echo-lucent space in the mitral-aortic intervalvular fi brosa in the parasternal longaxis and short-axis views. The non-coronary cusp of the aortic valve was fl ail and colour Doppler echocardiography demonstrated rupture of the aneurysm with communication to both left ventricular outfl ow tract and left atrium. There was severe aortic regurgitation with mild mitral regurgitation. The short axis view revealed large vegetation attached to the non-coronary cusp of aortic valve with root abscess formation ( fi gure 2 and video 2 ). He died due to refractory heart failure. This case illustrates possible complications of aortic valve endocarditis fl ail leafl et, severe aortic regurgitation, rupture of intervalvar fi brosa aneurysm, root abscess and complete heart block.