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Rupture of mitral-aortic intervalvular fibrosa aneurysm is a rare complication of aortic valve endocarditis.1 A 43-year-old man presented with persistent fever and progressive dyspnoea of 3 months duration. On admission, he was in florid pulmonary oedema and clinical examination showed findings of severe aortic regurgitation. His electrocardiogram revealed complete heart block with junctional escape rhythm. The echocardiogram showed an aneurysm of mitral-aortic intervalvular fibrosa in parasternal long-axis view (figure 1 and video 1). Such aneurysms are recognised echocardiographically as an echo-lucent space in the mitral-aortic intervalvular fibrosa in the parasternal long-axis and short-axis views. The non-coronary cusp of the aortic valve was flail and colour Doppler echocardiography demonstrated rupture of the aneurysm with communication to both left ventricular outflow 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 (figure 2 and video 2). He died due to refractory heart failure. This case illustrates possible complications of aortic valve endocarditis flail leaflet, severe aortic regurgitation, rupture of intervalvar fibrosa aneurysm, root abscess and complete heart block.
Competing interests None.
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