(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.