This is the case of a 67-year-old male with constitutional syndrome, fever, dyspnea, and a systolic-diastolic aortic murmur. The echocardiogram revealed the presence of aortic vegetation and a large pseudoaneurysm of anterior mitral valve location (Fig. 1-arrows) without valvular or peri-annular involvement, and positive blood cultures for Streptococcus salivaris. With a diagnosis of acute endocarditis, mitral-aortic replacement was performed under extracorporeal circulation. The left atriotomy revealed the presence of a violet giant pseudoaneurysm (Fig. 2A and B) of the entire serosanguineous anterior mitral valve (Fig. 2C and D). The postoperative period was uneventful with negative valve cultures. The association between a pseudoaneurysm post-endocarditis isolated from the anterior mitral valve leaflet without damage to the valve or mitral-aortic continuity is a rare finding. The echocardiogram is key here to select treatment and the optimal surgical time.

Figure 1

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Figure 2

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