Atypical left ventricular outflow tract aneurysm diagnosed by three-dimensional echocardiography

Abstract

A 14-YEAR-OLD WHITE FEMALE WAS BORN AT 37 weeks of gestation with a balanced Rastelli Type A atrioventricular septal defect. There was mild sub-aortic narrowing. There was a persistent left superior caval vein to a dilated coronary sinus. The inferior caval vein was not identified, and the abdominal aorta was to the left of the spine. A large azygous vein was seen draining to the right superior caval vein. The pulmonary venous connections were normal.At 11 weeks of age, she underwent two-patch repair of atrioventricular septal defect with reconstruction of the mitral valve and tricuspid valves. At 13 weeks, repeat mitral valve repair was performed. At 31 months, an additional repeat mitral valvuloplasty was performed. At 34 months, mitral valve replacement with a No. 21 Saint Jude prosthesis was carried out. A dual-chamber epicardial pacemaker was implanted for post-surgical heart block. Culture of the native mitral valve was found to be positive for bacillus infection and she was treated with clindamycin. At 9 years of age, she underwent mitral valve replacement with a No. 25 Saint Jude prosthesis, and septal myectomy through the aortic valve.The patient has been clinically stable and doing well for 5 years. Serial echocardiograms were performed and demonstrated stable cardiac findings. Intact atrial and ventricular patches, normally functioning No. 25 Saint Jude prosthesis in the mitral position, no residual or recurrent sub-aortic obstruction, mild aortic valve regurgitation, interrupted inferior caval vein with azygous continuation to the superior caval vein, mild left ventricular enlargement with slightly abnormal/dyssynchronous systolic contractility.At 13 years of age, a routine complete echocardiogram was performed including three-dimensional imaging. 1 Using an IE33 system (Philips Medical Systems, Andover, Massachusetts, United States of America), two-and three-dimensional imaging was accomplished. The S5-sector array probe was used for the two-dimensional imaging and the X3-1 matrix array probe for the three-dimensional imaging.In this study, an echolucent area lateral to the aortic valve and contiguous with the left ventricular outflow tract could be seen, and measured approximately 17 millimetre by 22 millimetre. This area appeared to expand and contract with ventricular systole and diastole. Clip 1: two-dimensional parasternal short axis.In some video clips, this echolucent area seemed to be in communication with the left anterior descending coronary artery, and was first thought to be a coronary artery aneurysm. This area could not be conclusively seen from other views. Clip 2: twodimensional parasternal short axis sliding medially towards the aortic root.Using the matrix array three-dimensional transducer, several full-volume data sets were obtained from the parasternal window, taking care to use settings that yield the largest area of view and with the highest frame rate. The data sets were obtained with held respirations over four cardiac cycles.

Pseudoaneurysm of the mitral‐aortic intervalvular fibrosa following endocarditis and aortic valve surgery in an infant—Case report and exhaustive systematic review of pediatric cases

“…References of all included articles were searched for any additional reports. There were a total of 46 pediatric patients aged 0–21 years in 35 reports, including our case 1–34 . P‐MAIVF cause was assigned based on the original authors of the reports.…”

Interventricular Septal Aneurysm: an Exceptional cause of Sudden Death in Young Adult

“…Ventricular tachycardia was also reported [13,14] with good response to surgical or catheter ablation in treated cases. Ventricular outflow obstruction concerns mostly the right tract [15][16][17], exceptionally, the VSA can bulge into the left ventricular outflow tract leading to a functional aortic stenosis [8,[18][19][20]. Bacterial endocarditis and thromboembolic accidents were also reported as complications of VSA [21][22][23].…”

Aneurysms and Dissections

“…[85][86][87][88] Complications of these aneurysms include arrhythmias, rupture, pericardial tamponade, pseudoaneurysm, thrombosis, thromboembolism, and mitral regurgitation. The etiologies can be congenital or acquired, including infections and ischemia.…”