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

BACKGROUND Pseudoaneurysms of the sinus of Valsalva (SOV) are rare and potentially life-threatening. Simultaneous pseudoaneurysms involving multiple sinuses and the ascending aorta are extremely uncommon. These lesions can exert a mass effect on adjacent cardiac structures, leading to valve dysfunction and heart failure. CASE REPORT We present the case of a 35-year-old man who was referred with progressive dyspnea and signs of heart failure. Although a prior febrile illness raised suspicion for an infectious etiology, the definitive cause remained indeterminate due to negative microbiological and serological workup. Initial imaging suggested an aortic dissection; however, further evaluation revealed large pseudoaneurysms in the left and right sinuses of Valsalva and the ascending aorta. Severe mitral regurgitation was noted, attributed to extrinsic annular distortion from the large left SOV pseudoaneurysm. The patient underwent urgent surgical intervention, including closure of the left and right SOV pseudoaneurysm orifices with bovine pericardial patches, excision of the ascending aortic pseudoaneurysm, and mitral valve annuloplasty 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. CONCLUSIONS This case illustrates a rare constellation of multiple SOV pseudoaneurysms. Crucially, it highlights the mechanistic link between the pseudoaneurysm's mass effect and functional mitral regurgitation. Timely surgical management corrected the anatomical defects and restored hemodynamic function. Awareness of such unusual presentations is essential for accurate diagnosis and prompt intervention.