Inferior cardiac aneurysm involving the interventricular septum. A complication of an acquired ventricular septal defect.

Abstract

summARY An acquired ventricular septal defect led to the formation of an unusual aneurysm within and overlying the posteroinferior part of the interventricular septum. This is a rare complication of a myocardial infarction and may not have been reported before. The aneurysm probably developed because of a combination of the anatomical localisation of the small ventricular septal defect and the long survival of the patient after its formation.Rupture of the interventricular septum and formation of an aneurysm are both well recognised complications of myocardial infarction. I report a case in which an acquired ventricular septal defect following an inferior myocardial infarction was complicated by the formation of a cystic dilatation within the posteroinferior part of the interventricular septum and the overlying inferior wall of the heart. Case report CLINICAL HISTORYAn 84 year old woman presented in 1983 with a four hour history of severe central chest pain associated with prolonged shortness of breath and vomiting on the day before admission. Examination showed severe left ventricular failure with a blood pressure of 110/70 mm Hg and a sinus tachycardia of between 100 and 120 beats/min. There was a precordial systolic thrill and a loud widespread pansystolic murmur. Despite diuretic treatment and a dopamine infusion her condition deteriorated, and she died shortly after admission.In 1968 hypertension had been noted when she presented with angina, and this had been controlled medically. In 1972 she had an inferior myocardial infarction which was complicated by the appearance of a loud pansystolic murmur and left ventricular failure. Subsequent cardiac catheterisation showed a ventricu-

Fourteen-Year Survival in a Case of Ventricular Septal Perforation after Myocardial Infarction.

“…Because of its grave prognosis and the progress of surgical techniques, the recent therapeutic strategy for VSP is to surgically repair it as soon as possible. Therefore, there are few reports on cases ofVSPwhohave survived for long time without surgical treatment, with only 14 cases documented in Japan and overseas (2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15) (Table 1). Weencountereda rare case with VSPwhowasundiagnosed for 9 years after myocardial infarction and still remains asymptomatic 14 years later.…”