Tricuspid Pouch can Cause Systemic Embolization in Adulthood

Takaki, Akira; Wakeyama, Takatoshi; Iwami, Takahiro; Kimura, Masayuki; Uchinoumi, Hitoshi; Akashi, Shintarou; Matsuda, Susumu; Miyazaki, Yousuke; Matsuzaki, Masunori; Okada, Haruhiko; Nishida, Masahiko; Murakami, Masanori

doi:10.1253/circj.70.631

Cited by 9 publications

(13 citation statements)

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“…Takaki et al highlighted the eff ect of a jet stream, which created the tricuspid pouch. Th ey described several events in sequence: left-to-right shunt fl ow jet toward the tricuspid valve, followed by deposition of fi brin over the margins of the defect and adhesion of the septal leafl et of the tricuspid valve to the margin of the VSD (24). Recently, Cozijnsen et al presented echocardiography showing a small isolated VSD (with a diameter of 6 mm) in association with a giant AMS (25 mm in length with a diameter of 8 mm), suggesting that the AMS closed the VSD (25).…”

Section: Mechanisms Responsible For Spontaneous Vsd Closurementioning

confidence: 99%

“…Some authors believe that perimembranous VSD is closed by tricuspid pouch. During the process of natural VSD closure, the septal leafl et of the tricuspid valve forms a large tricuspid pouch (24). Th e tricuspid pouch closely resembles an AMS by echocardiography and thus the tricuspid pouch can be confused with AMS (24).…”

Section: Mechanisms Responsible For Spontaneous Vsd Closurementioning

confidence: 99%

“…During the process of natural VSD closure, the septal leafl et of the tricuspid valve forms a large tricuspid pouch (24). Th e tricuspid pouch closely resembles an AMS by echocardiography and thus the tricuspid pouch can be confused with AMS (24). Th e tricuspid pouch is created by the eff ect of a jet stream (24).…”

Section: Mechanisms Responsible For Spontaneous Vsd Closurementioning

confidence: 99%

“…Th e tricuspid pouch closely resembles an AMS by echocardiography and thus the tricuspid pouch can be confused with AMS (24). Th e tricuspid pouch is created by the eff ect of a jet stream (24). In contrast, AMS is formed by projection of the left ventricular pressure during spontaneous closure of a VSD (24, 31).…”

Section: Mechanisms Responsible For Spontaneous Vsd Closurementioning

confidence: 99%

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A Review of Spontaneous Closure of Ventricular Septal Defect

Zhang¹,

Ko²,

Guileyardo³

et al. 2015

Baylor University Medical Center Proceedings

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516Ventricular septal defect (VSD) is the most common congenital heart malformation and can be detected during the prenatal and postnatal period, in childhood, and in adulthood. Spontaneous closure of VSD can be determined through a variety of methods-echocardiography, Doppler color flow imaging, angiography, auscultation, and cardiac catheterization-and can be proven by pathological evidence at necropsy. There are two major types of VSD, membranous and muscular, as well as the perimembranous variety, which comprises variable portions of the adjacent muscular septum but lacks the membranous septum. VSD appears either as an isolated cardiac defect without other abnormalities or with several complex malformations. It has long been recognized that VSD can close spontaneously, but the incidence of spontaneous VSD closure is still uncertain. Since necropsy study of the hearts with VSD has rarely been reported, information on morphological features of spontaneous VSD closure remains limited. In addition, the mechanisms for spontaneous VSD closure are not fully understood. Herein, we present a brief review of the incidence of spontaneous VSD closure, morphological characteristics of the closure, and the main mechanisms responsible for the closure. INCIDENCE OF SPONTANEOUS VSD CLOSURETh e incidence of spontaneous ventricular septal defect (VSD) closure varies greatly, depending on the age and gender of subjects at spontaneous closure, the size and site of the defect, the types of defect, as well as the population studied, methods employed, and length of follow-up period. Table 1 presents available data on the incidence of spontaneous VSD closure.Age and gender. Age has been found to have a significant infl uence on the incidence of spontaneous VSD closure, whereas gender seems less likely to aff ect the incidence. Although spontaneous VSD closure can occur at any agegestation, infancy, childhood, adolescence, and adulthood (1)-it occurs most commonly during the fi rst 6 months of life (2), during the fi rst year (3, 4), or soon after the fi rst year of life (5). Afterward, the occurrence of closure declines progressively and occurs less commonly after the age of 10 (5). It has been documented that the incidence of the close increases with age, from 24% at 18 months of age to 50% at 48 months and 75% at 120 months (6). However, in older children, at 3.5 years old, the incidence declines sharply to 44% and then rises to 66% at 7 years and 75% at 10.5 years (6). A similar trend has been found in other reports, which showed 57% (109/190) of cases closed before 3 years of age, 89% (169/190) closed before 8 years of age (7), and 4% to 10% closed after the age of 17 (8, 9). During adulthood, the incidence of spontaneous VSD closure remarkably declines. One study showed that of 188 adults with VSD, 19 patients' (10%) VSD closed spontaneously between the age of 17 and 45 years, and the incidence of closure was greater in the 17-to 24-year age group than the 25-to 34-year group, the 35-to 44-year group, and the ≥45-year group (8)...

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Section: Mechanisms Responsible For Spontaneous Vsd Closurementioning

confidence: 99%

Section: Mechanisms Responsible For Spontaneous Vsd Closurementioning

confidence: 99%

Section: Mechanisms Responsible For Spontaneous Vsd Closurementioning

confidence: 99%

Section: Mechanisms Responsible For Spontaneous Vsd Closurementioning

confidence: 99%

See 2 more Smart Citations

A Review of Spontaneous Closure of Ventricular Septal Defect

Zhang¹,

Ko²,

Guileyardo³

et al. 2015

Baylor University Medical Center Proceedings

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“…Possible mechanisms of this process, besides the above-mentioned tricuspid septal leaflet involvement, are deposition of fibrin over the margins of the VSD in the presence of a left-to-right shunt flow jet [11]. Though there were no symptoms, apart from the palpitations at presentation, and cardiac function was adequate, progressive growth of the aneurysm can occur and may lead to complications in the future.…”

Section: Discussionmentioning

confidence: 99%

A ventricular septal defect with a giant appendiform aneurysm of the membranous septum

Cozijnsen

Maas

et al. 2012

Neth Heart J

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We report a case of a 39-year-old female with a ventricular septal defect (VSD) and a giant appendiform aneurysm of the membranous septum, illustrated by echocardiography and magnetic resonance imaging. From the literature a short review of the prevalence of spontaneous closure of VSDs together with the possible complications of persisting VSDs is presented. Since patients stay at risk in later years, follow-up at regular intervals is advised.Keywords Ventricular septal defect . Aneurysm membranous septum . Spontaneous closure . Echocardiography . Magnetic resonance imaging CaseA 39-year-old female presented to the hospital with palpitations. She was diagnosed at birth with a ventricular septal defect (VSD) for which she received cardiological followup until the age of five. On physical examination a late systolic-early diastolic murmur was heard. The electrocardiogram showed sinus rhythm with an incomplete right bundle branch block. On Holter monitoring normal sinus rhythm with sporadic premature atrial and ventricular complexes was seen. The palpitations subsided spontaneously. In the diagnostic workup, echocardiography showed a small isolated VSD with a diameter of 6 millimeter (mm) and a giant aneurysm of the membranous septum (AMS), with a 25 mm long tube, protruding into the right ventricle (RV) with a terminal diameter of 8 mm (Figs. 1a, b, 2a) (also movie). We could not detect a left-to-right (L-R) shunt (Figs. 1c, 2b). Apparently the aneurysm has closed the VSD. There was no obstruction of the right ventricular outflow tract. Otherwise no abnormalities were found on echocardiography, especially no signs of left ventricular (LV) volume overload, pulmonary hypertension or valvular incompetence. Additionally magnetic resonance imaging (MRI) was performed confirming the VSD and the giant appendiform AMS in an otherwise completely normal heart. (Fig. 3) DiscussionIsolated VSDs are the most common congenital heart malformation at birth, around 30-40 %, if bicuspid aortic valve is not counted [1]. VSD is the most frequent main diagnosis in the CONCOR database, the Dutch registry of adults with congenital heart disease [2]. In membranous VSDs spontaneous closure is frequent. During childhood, 23 % (0-33 %) of the small membranous VSDs close spontaneously [3] and after the age of 17, a smaller portion of 4-10 % close spontaneously [4,5]. Complete or partial closure may occur Electronic supplementary material The online version of this article

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Isolated Ventricular Septal Defect

Hoffman

2009

The Natural and Unnatural History of Congenital Heart Disease

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Tricuspid Pouch can Cause Systemic Embolization in Adulthood

Cited by 9 publications

References 12 publications

A Review of Spontaneous Closure of Ventricular Septal Defect

A Review of Spontaneous Closure of Ventricular Septal Defect

A ventricular septal defect with a giant appendiform aneurysm of the membranous septum

Isolated Ventricular Septal Defect

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