Submitral aneurysm: a rare cause of ventricular tachycardia

Abstract

A 42-year-old male presented with sustained ventricular tachycardia of left bundle branch block (LBBB) morphology with left axis deviation (figure 1A) that terminated with amiodarone infusion. He gave a history of episodic palpitations associated with giddiness. Transthoracic and transoesophageal echocardiography showed a wide necked submitral aneurysm measuring 5×5 cm with severe mitral regurgitation (figure 1B,C).Coronary angiogram revealed a dominant right coronary artery with spontaneous dissection of mid and distal segments with splaying of the distal branches overlying the aneurysm ( figure 2A,B). Ventricular tachycardia of right and left bundle branch block morphologies was induced with single ventricular extrastimuli during electrophysiological testing. MRI clearly demonstrated the aneurysm below the mitral valve ( figure 2C,D). The patient was prescribed oral amiodarone and advised surgical resection of submitral aneurysm with mitral valve repair or replacement.1 DISCUSSION Submitral aneurysm is rare outside African blacks and uncommonly presents with ventricular arrhythmias.2 While the aetiology is considered to be congenital, coronary abnormalities have occasionally been described in association with this condition, although the relationship of the coronary abnormality to the aneurysm is unclear in our patient.

Multimodality Imaging Assessment of Ischemic-Related Submitral Left Ventricular Pouch: A Case Report

“…While 85% of left ventricular aneurysms involve the anterior wall, posterior wall aneurysms are very infrequent. Clinical manifestations can range from heart failure to thromboembolic events, ventricular arrhythmias, and ventricular wall rupture [ 5 , 6 ]. In our case, the main complaint was dyspnea.…”

Submitral aneurysm: An unusual localization of aneurysm complicating a myocardial infarction: A case report

“…The atypical localization of the submitral aneurysm is a source of complications [ 4 ]. They can have a variety of clinical manifestations, such as heart failure, systemic thromboembolism, and ventricular wall rupture, myocardial ischemia due to coronary artery compression, ventricular arrhythmias, or even sudden cardiac death [ 8 , 9 ]. The presence of an expanding subvalvar aneurysm leads to distortion of the mitral annulus or the mitral cord, which is the most usual cause of mitral regurgitation [ 10 ].…”