Romelie Tuplano, MD
Vascular Medicine, Philippine Heart Center, Quezon
Title: Complication of Aortic Valve Endocarditis
Biography
Biography: Romelie Tuplano, MD
Abstract
Superior mesenteric artery (SMA) pseudoaneurysm, an extremely rare disease with incidence of 0.01 - 2.6% of the visceral artery aneurysm and pseudoaneurysm, is clinically relevant because of its high risk of rupture and mortality. Guideline regarding intervention in patients with pseudoaneurysm is still not established, hence, this case report can be one of the basis of managing such disease.
Case Summary: A 24-year-old female known with rheumatic heart disease was admitted due to recurrent fever, arthritis and easy fatigability and diagnosed with reactivation of rheumatic fever and infective endocarditis of aortic valve. Culture-guided antibiotics were given. In addition, palpable abdominal mass was also noted. CT aortogram was done showing large aneurysm arising from one of the distal branches of the superior mesenteric artery with contained rupture with chronic intermittent hemorrhage. She underwent emergency exploratory laparotomy, excision of contained rupture of pseudoaneurysm with ligation of iliojejunal artery (one of the branches of superior mesenteric artery). And then eventually, she underwent mitral and aortic valve replacement. Both procedures were successful and tolerated. She was then discharged improved and stable.
Conclusion: Detailed history and physical examination are must for clinicians to have high suspicion and to warrant further workup for early detection of pseudoaneurysm. Due to its high risk of rupture and mortality, surgical intervention of SMA pseudoaneurysm was prioritized first in our patient then followed by valve surgery which both have successful outcome.
Keywords: Superior mesenteric artery pseudoaneurysm, contained rupture, infective endocarditis, rheumatic heart disease, case report