Outcome of submitral aneurysm

Abstract

Introduction: Submitral aneurysm is a rare cardiac entity with outpouching in relation to the posterior annulus of the mitral valve. Multiple etiology have been described with the role of infection and inflammation with varied clinical presentation in different case reports. However, the literature on clinical outcome and follow-up is lacking.Material and Method: This retrospective, observational study included all the adult patients (>18 years) who were diagnosed with a submitral aneurysm. Epidemiological, demographic, laboratory, clinical management, and outcome data were extracted and followed for the endpoints of cardiac death, noncardiac death, recurrent hospitalization (due to heart failure, rupture, arrhythmic events, embolic events), surgical repair, and echocardiography parameters for mitral regurgitation or change in the size of the left ventricle for 1-year postdischarge from the index hospitalization.Results: A total of 10 patients were enrolled in the study with a mean age of 31.2 ± 11.1 years. Possible etiology could be established in only five (50%) patients (two patients had tuberculosis and three patients had acute coronary syndrome). At index hospitalization, nine (90%) patients had heart failure, two (20%) patients had rupture of a submitral aneurysm, four patients underwent surgery, and one patient expired. On follow-up of 1 year, one more patient underwent surgical repair while three patients expired. Conclusion:A submitral aneurysm is a rare cardiac entity with poor outcomes.

Submitral aneurysm: Exploring a rare pathology

“…In their case series on outcomes of submitral aneurysm (SMA), Aggarwal et al provide one of the largest known characterizations and follow-up studies of this infrequently reported pathology. 1 We commend the authors for offering this unique case series and believe it will generate further dialog on the topic. The series details the presentation, etiologies, and outcomes for 10 patients presenting with SMA at a single center.…”

“…SMAs are an extremely rare pathology typically found in young patients. [1][2][3] While they were originally described in Western and Southern African populations, SMAs have been identified in patients across a variety of races and ethnicities. 4 In contrast to posterior left ventricular aneurysms, which often occur due to ischemic etiology, SMAs are believed to be largely congenital in nature.…”

“…4 In contrast to posterior left ventricular aneurysms, which often occur due to ischemic etiology, SMAs are believed to be largely congenital in nature. 1,[4][5][6][7] The pathology likely stems from a weakening of the fibrous tissue of the posterior mitral annulus, which creates an outpouching between the annulus and the left ventricular endocardium that restricts the posterior mitral leaflet. 6 Nayak et al suggest the presence of a submitral curtain, a fibrous separation between the fibrous annulus and the left ventricular musculature, further predisposes patients to developing SMA.…”

“…6,10,11 While transmural infarction typically causes apical aneurysm, ischemia-induced SMAs have been documented in prior literature and in three patients in the authors' series. 1,7 Infectious agents such as human immunodeficiency virus (HIV) and tuberculosis have also been proposed as etiologies of SMA, as inflammation is suspected to contribute to the pathogenesis and may exacerbate the congenital pathology of SMA. However, it is still uncertain whether these infectious etiologies are causative or a coincidental reflection of the diseases endemic to the demographic in which SMA is typically found.…”

“…4 The importance of surgical intervention was emphasized in this series presented by Aggarwal et al, as two of the three patients who refused surgery died within 3 months. 1 The classical approach to SMA repair is extensively detailed in the literature dating back to 1963 by Drs. Schrire and Barnard.…”