An Unusual Left Ventricular Outflow Pseudoaneurysm: Usefulness of Echocardiography and Multidetector Computed Tomography for Surgical Repair

Abstract

Left ventricular outflow tract (LVOT) pseudoaneurysm is a rare but potentially lethal complication, mainly after aortic root endocarditis or surgery. Usually it originates from a dehiscence in the mitral-aortic intervalvular fibrosa and it arises posteriorly to the aortic root. Due to these anatomical features, its imaging assessment is challenging and surgical repair requires complex procedures. An unusual case of LVOT pseudoaneurysm is described. It was detected by transthoracic ecocardiography 7 months after aortic root replacement for acute endocarditis. Multidetector computed tomography (MDCT) confirmed the presence of a pouch located between the aortic root and the right atrium. Computed tomography also detected the origin of the pseudoaneurysm from the muscular interventricular septum of the LVOT, rather below the aortic valve plane. It was repaired with an extracardiac surgical approach, sparing the aortic root bioprosthesis previously implanted. The high-resolution three-dimensional details provided by the preoperative MDCT allowed us to plan a simple and effective surgical strategy.

Huge Multilobulated Left Ventricular Outflow Tract Pseudoaneurysm Presenting with Ventricular Tachycardia

“…The presence of right bundle branch block along with left axis deviation in the baseline electrocardiogram suggest erosion into the septal area by the LVOT pseudoaneurysm. Although transthoracic and transesophageal echocardiography can make a reliable diagnosis of LVOT pseudoaneurysm, 5) the patient in the present case had such a huge pseudoaneurysm that it required further imaging with computed tomography and invasive LV angiography along with coronary angiography. The natural history of LVOT pseudoaneurysm is not properly know.…”

Transesophageal echocardiographic guidance for percutaneous closure of aortic pseudoaneurysm using a type II Amplatzer vascular plug: a case report

“…Aortic PsA is a rare postoperative complication of cardiac surgery, probably due to graft infection, aortic dissection, connective tissue disorders, and excessive use of biologic glue [ 1 2 3 ]. It usually arises from a dehiscence in the mitral-aortic intervalvular fibrosa [ 8 ] and the most common site is previous aortic suture line after cardiac surgery. Development of the LVOT PsA, as in our case report, is very rare.…”

Interventricular membranous septal aneurysm: CT and MR manifestations

“…Frequently, IVMS aneurysm is an incidental finding in MDCT used for aortic valve surgery planning [ 17 ]. MDCT provides high resolution 3D anatomical details of interventricular septal defects, requiring less time and sedation than MR imaging, and also less post-processing time.…”

“…Choi et al reported no difference in morphology of IVMS aneurysms among patients with and without conduction abnormalities [ 12 , 18 ]. This aneurysm is distinguished from a diverticulum because it is surrounded by fibrous tissue instead of muscle [ 17 ].…”