Posterior left ventricular pseudoaneurysm after aortic valve replacement in a patient with rheumatoid arthritis: diagnosis by transesophageal echocardiography.

A 58-year-old man with seropositive rheumatoid arthritis underwent successful aortic valve replacement because of severe aortic regurgitation. One year later, prosthetic valve endocarditis was suspected clinically and he was referred for echocardiography. On transthoracic echocardiography an unusual echo-free space adjacent to the inferobasal segments of the left ventricle and extending behind the left atrium was visible. No further diagnostic information could be obtained from precordial examinations. Biplane transesophageal echocardiography demonstrated the presence of a pulsatile pseudoaneurysm of the left ventricle arising posteriorly, close to the anulus of the mitral valve. There was no evidence of endocarditis.