Intervalvular fibrosa pseudoaneurysm with projectile shunt flow to left atrium.

We report a case of intervalvular fibrosa pseudoaneurysm, causing massive shunt flow from the left ventricle below the left coronary cusp to the left atrium above the anterior mitral annulus, which was clearly demonstrated on preoperative three-dimensional transesophageal echocardiography. Superior extension of the right-sided left atriotomy toward the pseudoaneurysm, combined with transection of aorta and main pulmonary artery, provided its sufficient exposure. Its opening to the left ventricle was closed with a patch, leaving no residual shunt flow.