Mitral Regurgitation Caused by Concomitant Pseudoaneurysms of the Sinus of Valsalva and Ascending Aorta.

Simultaneous pseudoaneurysms involving multiple sinuses of Valsalva and the ascending aorta were identified in a 35-year-old man presenting with progressive dyspnea and heart failure.

• The patient was 35 years old and male.
• Presenting symptoms included progressive dyspnea and signs of heart failure.
• Pseudoaneurysms were located in the left sinus of Valsalva, right sinus of Valsalva, and ascending aorta.
• Simultaneous pseudoaneurysms involving multiple sinuses and the ascending aorta are described as 'extremely uncommon.'

Initial imaging suggested aortic dissection, but further evaluation revealed the lesions to be pseudoaneurysms.

• Initial imaging was misleading, pointing toward aortic dissection.
• Further evaluation was required to correctly identify large pseudoaneurysms in the left and right sinuses of Valsalva and the ascending aorta.
• The definitive etiology remained indeterminate due to negative microbiological and serological workup despite a prior febrile illness raising suspicion for an infectious cause.

Severe mitral regurgitation was attributed to extrinsic annular distortion caused by the large left sinus of Valsalva pseudoaneurysm.

• The mitral regurgitation was classified as severe.
• The mechanism was identified as extrinsic annular distortion from the mass effect of the large left SOV pseudoaneurysm.
• The native mitral valve leaflets were not intrinsically diseased; the dysfunction was functional in nature.
• This case highlights 'the mechanistic link between the pseudoaneurysm's mass effect and functional mitral regurgitation.'

The patient underwent urgent surgical intervention addressing all three pseudoaneurysms and the mitral valve.

• Left and right SOV pseudoaneurysm orifices were closed with bovine pericardial patches.
• The ascending aortic pseudoaneurysm was excised.
• Mitral valve annuloplasty was performed using a 30-mm Carpentier-Edwards Physio II ring.
• The aorta was reconstructed without the need for a prosthetic graft.

Postoperative recovery was uneventful and the patient was discharged on postoperative day 10.

• The patient was discharged on postoperative day 10.
• No postoperative complications were reported.
• Timely surgical management 'corrected the anatomical defects and restored hemodynamic function.'