Aorto-mitral intervalvular fibrosa pseudoaneurysm with mitral valve perforation after Manouguian aortic root enlargement

Abstract A 59-year-old patient developed heart failure symptoms five years after bioprosthetic surgical aortic valve replacement with Manouguian root enlargement. Multimodality imaging demonstrated an aorto-mitral intervalvular fibrosa pseudoaneurysm, suspected patch dehiscence, and a systolic jet from the left ventricular outflow tract to the left atrium. This case highlights the potential for delayed complications after Manouguian root enlargement, warranting careful long-term follow-up and evaluation.