An interventricular membranous septal aneurysm obstructing the right ventricle outflow tract in a five-year-old boy: a case report

Abstract

Background While the aneurysms of the membranous septum (AVS) are rare, the possibility that they lead to obstruction is even rarer. To the best of our knowledge, 11 similar cases have been reported since 1982. Case presentation Initially, the five-year-old boy was evaluated for dyspnoea that had been present since birth. He did not receive any medical treatment until the previous year. At the age of four, the transthoracic echocardiography showed a large aneurysm extending to the right ventricular outflow tract (RVOT) and causing RVOT stenosis. Complete surgical resection of the aneurysmal tissue was performed, and the boy was discharged home in satisfactory condition. Conclusions As the occurrence of RVOT obstruction by a membranous ventricular septal aneurysm is very rare, we are reporting the second case in which an aneurysm of the membranous septum dynamically obstructed the RVOT in a child. We are also reviewing all the previously reported similar cases in the literature. Further studies are needed to obtain a more comprehensive understanding of aneurysms of the membranous septum (AVS).

The Interventricular Septum: Structure, Function, Dysfunction, and Diseases

“…Less common pathologies affecting the IVS include aneurysm [ 66 ], diverticulum [ 67 ], and lipomatous hypertrophy [ 68 ]. Intramyocardial dissecting hematoma is a rare form of cardiac rupture that may occur following MI, chest trauma, or percutaneous intervention.…”

Right Ventricular Outflow Tract Obstruction by an Aneurysm of the Ventricular Membranous Septum: A Systematic Review of Case Reports

“…10,18,22 Tricuspid valve annuloplasty was performed in two cases. 27,34 Surgery for a membranous septal aneurysm was performed through right ventriculotomy in nine cases up to 1992, 8,9,12,13,15,17,[19][20][21] right atriotomy in seven cases in 1998 through 2020, 10,11,22,29,[33][34] aortotomy in one case, 32 incision of a huge membranous aneurysm in one case, 23 and right atriotomy and right ventriculotomy in one case. 27 In a case with pulmonary valve vegetation, pulmonary arteriotomy was added to the right atriotomy.…”

“…The pouch formation of the septal leaflet of the tricuspid valve in a perimembranous VSD causes a diminution of the shunt The right border of the AN sac was continuous with the TV Flege et al 13 Excision Direct AN of the STL Chesler et al 14 Resection Closure TP (ATL) Iida et al 8 Resection Mattress suture ND Cosio et al 15 Resection Patch (Felt) Membranous sac attached to the TV Silvestre et al 16 Plication ND TV competent Gomes et al 17 Excision Closure Wind-sock-flap (in relation to STL) Bonvicini et al 18 Reinforce Patch (Teflon) ND Nagaoka et al 9 Excision Patch (ND) ND Johnson et al 19 Excision Closed primarily ND Chadha et al 20 Excision Patch (Dacron) ND Sharma et al 21 Excision (major portion) Obliterated The membranous sac involved the base of the TV Kaneko et al 22 Closure 24 Excision Patch (Dacron) ND Güneşet al 25 Surgery (−) Love et al 6 Surgery (−) Sugino et al 26 Resection Direct ND Chen et al 27 Resection Small VSD closure Dilated Eason et al 7 Resection ND Aneurysmal TV tissue Altunbas et al 28 Resection Internal patch closure ND Bamous et al 29 Excision Patch (Dacron) ND Mahesh et al 30 Resection Patch (Dacron) AN formed by STL Privitera et al 31 Surgery (−) Velicki et al 32 Plication (transaortic) ND ND Bakr et al 33 Resection Patch (Dacron) ND Bride et al 34 Resection Patch (Gore-Tex) AN originate from STL Yamashita et al 10 Resection(−) Patch (Gore-Tex) AN continuing from STL Herron et al 35 Surgery (−) volume and can lead to spontaneous closure. 3 After pouch formation, it is extremely rare to require surgery for the right ventricular outflow tract obstruction.…”