[Pseudoaneurysm of the mitro-aortic trigone: Clinical case and literature review]

Abstract

Case report: We report the case of a 63-year-old patient who underwent aortic valve replacement with a biological valve for a bicuspid aortic stenosis, and LIMA-IVA single-bypass surgery. Two weeks later, he presented with Enterococcus faecillis bacteremia, attributed to left pyelonephritis and successfully treated with Amoxicillin. Two months after his surgery, he had a new bacteremia due to Enterococcus faecalis and we discovered a pseudo-aneurysm of the mitro-aortic trigone. Our patient is treated medically at first, before benefiting from the "Hemi-Commando" procedure.

Discussion: The mitro-aortic trigone is a fibrous area, located between the left half of the noncoronary cusp and the left coronary cusp of the aortic valve and the anterior leaflet of the mitral valve [1]. This area, important in the maintenance of mitral and aortic functions, [ii] is poorly vascularized and therefore very susceptible to infections and trauma [2]. Erosion of the aortic ring leads to the formation of a subvalvular abcess, secondarily detergated en then leads to the destruction of the trigone.

Conclusions: Pseudoaneurysm is a rare complication of aortic valve surgery and endocarditis. Given the risk of rupture, early surgery is recommended.

Keywords: Commando procedure; Endocardite; Endocarditis; Procédure « Commando »; Pseudoaneurysm; Pseudoanévrisme.