Redo aortic root replacement (Cabrol procedure) and Commando operation for extensive prosthetic valve endocarditis with aortic root pseudoaneurysm involving mitral-aortic intervalvular fibrosa.

Mitral-aortic intervalvular fibrosa pseudoaneurysm is a rare but potentially fatal complication, most commonly arising from infective endocarditis or a prior cardiac operation. Rupture of a mitral-aortic intervalvular fibrosa pseudoaneurysm constitutes a surgical emergency and presents considerable technical challenges, with reported early mortality rates between 20% and 30%. We report the case of a high-risk 72-year-old man with a history of two prior cardiac operations who presented with a contained rupture of a mitral-aortic intervalvular fibrosa  pseudoaneurysm and an aortic root abscess. Surgical management involved mitral-aortic intervalvular fibrosa reconstruction using a double-layer bovine pericardial patch within a Commando operation with a modified bio-Bentall procedure and coronary artery reimplantation via a Cabrol procedure. This integrated approach enabled complete debridement of the infected aortic root tissue and successful repair of the mitral-aortic intervalvular fibrosa defect, highlighting the value of combining these complex techniques in select high-risk reoperative settings.