(3).
Echocardiographically, pseudoaneurysms of the MAIF appear as pulsatile, narrow-
necked echo-free outpouchings situated between the base of the anterior mitral
valve leaflet and the inferior margin of the non-coronary sinus of the aortic root. On
color-flow Doppler examination they demonstrate to-and-fro flow with the LV
outflow tract.
Pseudoaneurysms of the MAIF protrude externally in between the LA and the aortic root with which they may form fistulous communications(2). Alternatively, they may perforate and drain freely into the pericardial space resulting in suppurative pericarditis(2). The present case is notable for fistulous communication with the LA which produced flow within the atrium that simulated severe MR. Careful scanning however confirmed that this flow did not arise from an incompetent mitral valve. Last, it is important to appreciate that fistulous flow into the LA has the same hemodynamic consequences as MR and may result in LA and LV volume overload.