Left Ventricular Aneurysm in Rubella Heart Disease

Abstract

A 3-year-old patient with the rubella syndrome was studied by cardiac catheterization and cineangiography and was found to have an aneurysm of the left ventricle in addition to a persistent ductus arteriosus and hypoplasia with coarctations of the pulmonary arteries. The ductus arteriosus was ligated and divided, and residual myocardial dysfunction was demonstrated six months after surgery. The aneurysm is considered to be directly related to rubella myocarditis which occurred at an earlier age in association with other areas of myocarditis resulting in a myopathic disorder. Gregg1 first described the rela¬ tionship between rubella and congenital malformations, and nu¬ merous reports have appeared de¬ scribing the association between the rubella virus and cardiovascular dis¬ ease. Hastreiter et al2 found pulmo¬ nary artery anomalies in all of their cases, a patent ductus arteriosus in 75% of cases, and hypoplasia of the aortic isthmus in 16% of their series. Other cardiovascular diseases include myocarditis,3 renal artery stenosis," supravalvar aortic stenosis,5 and coro¬ nary artery sclerosis.6 Septal defects and other rarer malformations have also been described.7It is the purpose of this report to describe a child with the stigmata of the congenital rubella syndrome who also has an apical aneurysm of the left ventricle, a patent ductus arte¬ riosus, and pulmonary arterial hypo¬ plasia with coarctation confirmed by cardiac catheterization, selective cineangiocardiography, and surgery. A similar combination of lesions has not been reported previously. Report of a CaseAn Indian boy was seen initially at 17 months of age; he was deaf and had phys¬ ical and developmental retardation and microcephaly (skull circumference, 41 cm). The mother denied a history of rubella in pregnancy, but a diagnosis of the rubella syndrome was made on the clinical fea¬ tures and the demonstration of significant elevation of the titer of rubella neutral¬ izing antibodies. There was a hemaggluti¬ nation inhibiting antibody titer of 1:256 against rubella antigen. No rubella virus was isolated from a throat swab or urine. A continuous murmur was heard under the left clavicle and suggested that he had a persistent ductus arteriosus. The patient remained well until he was 3 years old when he presented with heart failure for the first time. He had bounding pulses, a large thrusting left ventricle, a loud, widely split but mobile second heart sound, an apical mid-diastolic murmur, and a loud continuous murmur under the left clavicle which radiated through to the back. The initial hemoglobin concentration was 5.5 gm/100 cc; the red cells showed a pattern of iron deficiency, and the ab¬ normality probably contributed to his heart failure. The electrocardiogram is shown in Fig 1 and the chest roentgeno¬ gram before ductal surgery and six months later in Fig 2. Blood was trans¬ fused, and heart failure was treated with digitalis. Catheterization of the left and right sides of the heart with selective angiocardiography was performed to

Myocardial aneurysm in association with disseminated cytomegalovirus infection

“…Thrombosis has also been observed to occur adjacent to foci of intimal irregularity and thickening [6], such foci being frequently found in autopsy studies of newborn infants [8] . Coronary artery thrombosis in Infancy has not been found at autopsy in the typical cases of interstitial myocarditis [2] and was not found at angiography in the reported case of left v entricular aneurysm complicating suspected congenital rubella and cardiomyopathy [15] . In the infant described here, none of the aforementioned Pathological processes appear to have played a role .…”