LEFT VENTRICULAR ANEURYSMS OF UNCERTAIN AeTIOLOGY

Abstract

An unusual type of annular, subvalvular left ventricular aneurysm has recently been described in Nigerians by Robertson and Jackson (1960) and Abrahams et al. (1962). A search revealed reports of similar cardiac aneurysms of unknown etiology (Corvisart, 1813;Hunter and Benson, 1933;Berlin and Hallen, 1938;Burn, Hollander, and Crawford, 1943;Higginson and Keeley, 1951;Brink and Barnard, 1954;Clearkin and Bunje, 1955; Lurie, 1960). With one possible exception (Martin, 1946) all the cases hitherto described have been Negroes. The modes of presentation have been diverse. Congestive cardiac failure, pulmonary cedema, or sudden death from pericardial tamponade following rupture of an aneurysm have been reported frequently. Other cases have been asymptomatic, and an abnormal radiological cardiac outline has led to their detection. A large proportion ofthese patients have, had murmurs ofmitral incompetence, and the regurgitation has been confirmed by angiocardiograms in some. Necropsy has revealed stretching and dilatation of the mitral ring produced by these aneurysms due to their extension in an annular fashion around the valve ring. In the majority of patients the electrocardiogram has shown surprisingly little abnormality even in the presence of multiple large aneurysms. Generalized low voltage, slight S-T segment depression with flat or inverted T waves in the limb leads and left ventricular chest leads were usually recorded (Abrahams et al., 1962). This paper describes two further patients with subvalvular aneurysms, one of whom is a European. The electrocardiogram in both patients suggested myocardial infarction. In the second patient interesting auscultatory features were present, which have not previously been described in association with these cardiac aneurysms. (Fig. 1). 184 on 12 May 2018 by guest. Protected by copyright.

Late systolic murmurs and non-ejection ("mid-late") systolic clicks. An analysis of 90 patients.

“…Reid (1961) revived the postulate that mid-late systolic clicks and late systolic murmurs were of mitral valvular origin. Recent evidence Segal and Likoff, 1964;Barlow, 1965;Pocock et al, 1965;Ronan, Perloff, and Harvey, 1965;Kesteloot and Van Houte, 1965;Tavel, Campbell, and Zimmer, 1965;Criley et al, 1966;Linhart and Taylor, 1966;Hancock and Cohn, 1966;Leighton et al, 1966;Leon et al, 1966;Stannard et al, 1967) supports our belief that these late systolic murmurs always denote mitral incompetence and that the clicks are intracardiac, and probably chordal, in origin. The late systolic murmur of mitral incompetence has a characteristic cadence and may periodically develop a musical intonation.…”

Cardiac ventricular aneurysm

“…This takes the form of an annular subvalvar aneurysm affecting the left ventricle close to the mitral ring. It often gives rise to mitral regurgitation, by stretching the mitral ring and by interfering with the function of the papillary muscles, chordae tendineae, and cusps of the mitral valve (Lurie, 1960;Pocock, Cockshott, Ball, and Steiner, 1965).…”

Annular subvalvular left ventricular aneurysm in Bahia, Brazil.

“…Though a congenital defect of the left ventricular wall near the atrioventricular groove is difficult to prove, this may be a possible cause of these aneurysms, as proposed by Abrahams et al (1962). The genetic basis suggested by the susceptibility among blacks seems unlikely, since one of the cases reported by Pocock et al (1965) and one of our cases are caucasian.…”