Pseudoaneurysm formation in infective endocarditis

Left ventricular pseudoaneurysms that develop in the setting of infective endocarditis are believed to result from remodeling of extravalvular abscesses. The high pressure generated by the left ventricle is thought to dissect into the abscess causing it to form a characteristic sac-like protuberance readily recognized echocardiographically. Left ventricular pseudoaneurysms most often arise from abscesses in the mitral-aortic intervalvular fibrosa and protrude external to the aorta. Less often, as described herein, they arise from abscesses external the posterior mitral annulus and project into the posterior interventricular groove. Perforation may result in camo-cameral or aorto-cameral fistula formation, as well as fistulous communication with the pericardial space. Mini-Abstract Left ventricular pseudoaneurysms that develop in the setting of infective endocarditis rarely occur in the posterior interventricular groove. Herein, we present a case complicated by left ventricular to left atrial fistula formation presenting as congestive heart failure. Following medical stabilization, the patient underwent successful mitral valve repair surgery.