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Hu G, Lv Z, Ding J, Muhammad I, Zhu X. Echocardiographic features of a giant aneurysm of membranous ventricular septum. J Cardiothorac Surg 2024; 19:343. [PMID: 38907275 PMCID: PMC11191189 DOI: 10.1186/s13019-024-02882-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2024] [Accepted: 06/15/2024] [Indexed: 06/23/2024] Open
Abstract
We describe the echocardiographic features of a 22-year-old female with a giant aneurysm of membranous ventricular septum (AMVS). Both transthoracic echocardiography (TTE) and transesophageal echocardiography (TEE) demonstrated significant dilatation of the aortic annulus and severe aortic regurgitation. A giant aneurysm was detected extending from a large membranous ventricular septal defect (MVSD) to the anterior surface of the aortic root. Contrast-enhanced CT and three-dimensional CT revealed a giant aneurysm located below the aortic root and connected to the left ventricular outflow tract (LVOT). The diagnosis was confirmed by surgery and postoperative pathological examination.
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Affiliation(s)
- Guobing Hu
- Department of Ultrasound, the First Affiliated Hospital of Wannan Medical College, Wuhu, Anhui, 241001, China
| | - Zhen Lv
- Department of Ultrasound, the First Affiliated Hospital of Wannan Medical College, Wuhu, Anhui, 241001, China.
| | - Jie Ding
- Department of Ultrasound, the First Affiliated Hospital of Wannan Medical College, Wuhu, Anhui, 241001, China
| | - Ishaq Muhammad
- Department of Ultrasound, the First Affiliated Hospital of Wannan Medical College, Wuhu, Anhui, 241001, China
| | - Xiangming Zhu
- Department of Ultrasound, the First Affiliated Hospital of Wannan Medical College, Wuhu, Anhui, 241001, China
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2
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Miyake T, Inoue T, Mushiake S. Right Ventricular Outflow Tract Obstruction by an Aneurysm of the Ventricular Membranous Septum: A Systematic Review of Case Reports. World J Pediatr Congenit Heart Surg 2024; 15:380-388. [PMID: 38263669 DOI: 10.1177/21501351231215258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2024]
Abstract
We performed a literature search to identify the details of patients with right ventricular outflow tract obstruction caused by an aneurysm of the ventricular membranous septum in a perimembranous ventricular septal defect. Thirty-one cases with a median age of 29 years (range, 1-69 years) were studied. A right ventricle-pulmonary artery systolic pressure gradient ranged from 35 to 107 mm Hg (mean 69 mm Hg). An interventricular shunt was absent in eight patients: two children and six adults. It is necessary to monitor the size of an aneurysm of the ventricular membranous septum, whether or not an interventricular shunt is present.
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Affiliation(s)
- Toshiharu Miyake
- Department of Pediatrics, Kindai University Nara Hospital, Ikoma, Nara, Japan
| | - Tomohiro Inoue
- Department of Pediatrics, Kindai University Nara Hospital, Ikoma, Nara, Japan
| | - Sotaro Mushiake
- Department of Pediatrics, Kindai University Nara Hospital, Ikoma, Nara, Japan
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3
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Liu Z, Liang T, Jia S, Zhang W, Feng Y, Huang H. A case presentation of acquired membranous ventricular septum aneurysm as a rare delayed complication of ventricular septal defect repair surgery: 10-year follow-up. BMC Cardiovasc Disord 2023; 23:346. [PMID: 37438743 DOI: 10.1186/s12872-023-03361-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Accepted: 06/21/2023] [Indexed: 07/14/2023] Open
Abstract
BACKGROUND Rare as membranous ventricular septal aneurysms (MVSA) is, the possibility that occurs after ventricular septum defect (VSD) repair surgery is even more uncommon. PRESENTATION A girl developed a MVSA 3 years after the VSD repair surgery at the age of 1 and increasing growth was noted during the follow-up. Aneurysm plication was carried done when she was 11 years old because it was observed to have a close relationship to the right coronary and obstructed the right ventricular outflow tract. Postoperative echocardiography follow-up revealed no abnormalities. CONCLUSION Though the prognosis of most patients with VSD repaired surgery was good, there remains varieties type of complications despite surgical advances. Accurate and rapid diagnosis of acute and delayed complications is essential to improve prognosis. In this case, the aneurysm was diagnosed by multiple imaging modalities and the girl underwent successful surgery again which provides direction for awareness and knowledge of delayed complications of VSD repair.
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Affiliation(s)
- Zhiyue Liu
- Department of Cardiology, West China Hospital of Sichuan University, Guoxue Xiang 37, Chengdu, 610041, China
| | - Ting Liang
- Department of Cardiology, West China Hospital of Sichuan University, Guoxue Xiang 37, Chengdu, 610041, China
| | - Siyu Jia
- Department of Cardiology, West China Hospital of Sichuan University, Guoxue Xiang 37, Chengdu, 610041, China
| | - Wen Zhang
- Department of Ultrasound, West China Second University Hospital, Sichuan University, Chengdu, 610000, China
| | - Yuan Feng
- Department of Cardiology, West China Hospital of Sichuan University, Guoxue Xiang 37, Chengdu, 610041, China.
| | - He Huang
- Department of Cardiology, West China Hospital of Sichuan University, Guoxue Xiang 37, Chengdu, 610041, China.
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Colonna P, Giovannetti G, Tota A, Palmieri V. Incidental echocardiographic finding of a membranous ventricular septal aneurysm in an 18-year-old asymptomatic athlete. J Cardiovasc Echogr 2022; 32:134-136. [PMID: 36249428 PMCID: PMC9558640 DOI: 10.4103/jcecho.jcecho_10_22] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Accepted: 03/14/2022] [Indexed: 11/05/2022] Open
Abstract
Membranous ventricular septal aneurysm (VSA) is an uncommon cardiac abnormality, potentially leading to several cardiac complications such as aortic valve prolapse, arrhythmias, and aneurysm rupture. A young competitive soccer player presented for a post-COVID sports cardiology assessment, denying any previous cardiological evaluations. On transthoracic echocardiography, a membranous VSA was incidentally found with no other cardiac abnormality nor hemodynamic impairment associated. A well-oriented anamnesis guided by echocardiographic findings revealed that a ventricular septal defect was diagnosed at birth with spontaneous closure at 4 years old. From that moment, no further follow-up was performed. Before granting cardiological approval to competitive sport, transesophageal echocardiography and Holter electrocardiogram were performed to confirm the absence of interventricular shunt and any other cardiac abnormality or arrhythmias associated with VSA. This case highlights the value of an accurate and comprehensive clinical and echocardiographic evaluation when performing a cardiological sports assessment, even in a young asymptomatic athlete.
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Nandi D, Shaw M, Arvind B, Taxak A, Kumar S, Saxena A. Interventricular membranous septal aneurysm is seen on multidetector computed tomography in postoperative child. J Card Surg 2021; 36:4751-4753. [PMID: 34643297 DOI: 10.1111/jocs.16064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2021] [Revised: 09/27/2021] [Accepted: 10/01/2021] [Indexed: 12/01/2022]
Abstract
BACKGROUND Ruptured interventricular septal aneurysms are rare. We present a case of an interventricular membranous septal aneurysm in a 7-year-old boy who presented with features of congestive heart failure, 2 years after undergoing a patch closure of perimembranous ventricular septal defect and tricuspid valve repair. Material and methods and results: Transthoracic echocardiography suggested the presence of an aneurysm that has ruptured into the right ventricle (RV), however, the precise origin of the aneurysm could not be identified on echocardiography. Subsequently, a computed tomography (CT) angiography was done which revealed that the aneurysm was originating from the membranous interventricular septum with evidence of rupture into the RV inflow. DISCUSSION Due to its close proximity to the aortic annulus, an aneurysm of the membranous interventricular septum may be confused with a sinus of Valsalva aneurysm, especially if the former is associated with aortic regurgitation. CONCLUSION This case highlights the importance of CT in the precise differentiation of these two abnormalities.
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Affiliation(s)
- Debanjan Nandi
- Department of Cardiovascular Radiology & Endovascular Interventions, All India Institute of Medical Sciences, New Delhi, India
| | - Manish Shaw
- Department of Cardiovascular Radiology & Endovascular Interventions, All India Institute of Medical Sciences, New Delhi, India
| | - Balaji Arvind
- Department of Cardiology, All India Institute of Medical Sciences, New Delhi, India
| | - Avichala Taxak
- Department of Cardiovascular Radiology & Endovascular Interventions, All India Institute of Medical Sciences, New Delhi, India
| | - Sanjeev Kumar
- Department of Cardiovascular Radiology & Endovascular Interventions, All India Institute of Medical Sciences, New Delhi, India
| | - Anita Saxena
- Department of Cardiology, All India Institute of Medical Sciences, New Delhi, India
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Assaf A, Berry R, Mantha Y, Zughaib M, Saba S. Isolated Ventricular Septal Aneurysm: A Differential Diagnosis for a Right Sinus of Valsalva Aneurysm. AMERICAN JOURNAL OF CASE REPORTS 2021; 22:e930930. [PMID: 34023848 PMCID: PMC8164883 DOI: 10.12659/ajcr.930930] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Revised: 04/15/2021] [Accepted: 04/09/2021] [Indexed: 11/10/2022]
Abstract
BACKGROUND A ventricular septal aneurysm (VSA) is rare and almost always an incidental finding on cardiac imaging. It is rarely an isolated phenomenon and is more commonly associated with other forms of congenital heart disease such a ventricular septal defect (VSD). Differentiating a ventricular septal aneurysm from an aneurysm of the right sinus of Valsalva is crucial as the latter usually has a more aggressive course and may require surgical intervention. Cardiac computed tomography (cardiac CT) or cardiac magnetic resonance imaging (CMR) may help confirm the diagnosis. CASE REPORT We report a case of a 42-year-old obese Japanese man with a past medical history of hyperlipidemia who described occasional effort-related palpitations when climbing stairs over the past few months but no anginal symptoms. Echocardiogram revealed normal left ventricular systolic with a presumed right sinus of Valsalva aneurysm measuring around 1.5 cm. A coronary CTA was obtained to further delineate the aneurysm and revealed normal CT angiographic appearance of a right dominant coronary artery circulation with a small aneurysmal outpouching of the membranous ventricular septum measuring 13×17 mm without any evidence of shunting, along with focal calcification of the medial aspect of the tricuspid annulus. The right sinus of Valsalva appeared normal on coronary CTA. CONCLUSIONS Membranous ventricular septal aneurysm is a rare condition that is almost always an incidental finding on echocardiography and can be mistaken for an aneurysm of the right sinus of Valsalva. Multimodality imaging and high degree of clinical suspicion are needed to accurately diagnose a ventricular septal aneurysm and to achieve favorable outcomes. A VSA usually has a benign course and is rarely a cause of arrythmia, right ventricular outflow obstruction, or valvular insufficiency.
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Affiliation(s)
- Andrew Assaf
- Department of Cardiology, Ascension Providence Hospital, Southfield, MI, U.S.A
| | - Ryan Berry
- School of Medicine, Michigan State University, Lansing, MI, U.S.A
| | - Yogamaya Mantha
- Department of Internal Medicine, Texas Health Presbyterian Hospital of Dallas, Dallas, TX, U.S.A
| | - Marcel Zughaib
- Department of Cardiology, Ascension Providence Hospital, Southfield, MI, U.S.A
| | - Souheil Saba
- Department of Cardiology, Ascension Providence Hospital, Southfield, MI, U.S.A
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Sinha M, Pandey NN, Sharma A, Parashar N, Kumar S, Sharma G. Aneurysmal and obstructive lesions of the left ventricular outflow: evaluation on multidetector computed tomography angiography. Pol J Radiol 2021; 86:e195-e203. [PMID: 34093915 PMCID: PMC8147719 DOI: 10.5114/pjr.2021.105588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2020] [Accepted: 08/06/2020] [Indexed: 11/30/2022] Open
Abstract
The left ventricular outflow is an anatomically complex region situated between the anterior leaflet of the mitral valve and the left ventricular aspect of the muscular and membranous interventricular septum. It gives rise to the aorta, provides support to the aortic valvular cusps, and houses important components of the conduction system. The left ventricular outflow handles high pressures and pressure variations and is subsequently affected by a variety of aetio-pathological conditions. Diseases involving the left ventricular outflow can be intraluminal, mural, or extramural, and the consequent complications of the lesions can be local, loco-regional, or even systemic. Appropriate evaluation requires comprehensive multimodality imaging with each modality contributing to assessment of different aspects of diagnosis, lesion characterization, local extension, prognostication for systemic complications and mortality, and the decision for the approach and type of intervention and aggressive follow-up in case non-interventional management is decided. In this review, we briefly describe the relevant anatomy and the gamut of structural abnormalities pertaining to the left ventricular outflow on multidetector computed tomography angiography.
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Affiliation(s)
| | | | - Arun Sharma
- Correspondence address: Dr. Arun Sharma, 148, The Foothills, New Chandigarh (Pb), India, e-mail:
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Bride P, Kaestner M, Radermacher M, Vitanova K, von Scheidt F, Scharnbeck D, Apitz C. Spontaneous Closure of Perimembranous Ventricular Septal Defects: A Janus-Faced Condition. CASE (PHILADELPHIA, PA.) 2020; 4:103-105. [PMID: 32337401 PMCID: PMC7175755 DOI: 10.1016/j.case.2019.08.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
•Large perimembranous VSDs can occasionally close spontaneously by a septal aneurysm. •Complications of aneurysmatic VSD closure include RVOT obstruction. •The use of multimodal imaging allows accurate diagnosis of RVOT obstruction. •RVOT obstruction due to septal aneurysm is preferably treated by surgical excision. •Patients with aneurysmatic closure of perimembranous VSD need life-long observation.
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Affiliation(s)
- Peter Bride
- Division of Adult Congenital Heart Disease, Ulm University Hospital, Ulm, Germany
- Division of Pediatric Cardiology, Children's Hospital, Ulm University, Ulm, Germany
| | - Michael Kaestner
- Division of Adult Congenital Heart Disease, Ulm University Hospital, Ulm, Germany
- Division of Pediatric Cardiology, Children's Hospital, Ulm University, Ulm, Germany
| | - Michael Radermacher
- Division of Adult Congenital Heart Disease, Ulm University Hospital, Ulm, Germany
- Department of Medicine II, Ulm University Medical Center, Ulm, Germany
| | - Keti Vitanova
- Department of Cardiovascular Surgery, German Heart Centre, Munich, Germany
| | - Fabian von Scheidt
- Division of Adult Congenital Heart Disease, Ulm University Hospital, Ulm, Germany
- Division of Pediatric Cardiology, Children's Hospital, Ulm University, Ulm, Germany
| | - Dominik Scharnbeck
- Division of Adult Congenital Heart Disease, Ulm University Hospital, Ulm, Germany
- Department of Medicine II, Ulm University Medical Center, Ulm, Germany
| | - Christian Apitz
- Division of Adult Congenital Heart Disease, Ulm University Hospital, Ulm, Germany
- Division of Pediatric Cardiology, Children's Hospital, Ulm University, Ulm, Germany
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9
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Aortocavitary fistula secondary to vegetative endocarditis in a rabbit. J Vet Cardiol 2019; 21:49-56. [PMID: 30797445 DOI: 10.1016/j.jvc.2018.08.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2018] [Revised: 08/20/2018] [Accepted: 08/21/2018] [Indexed: 11/22/2022]
Abstract
A 4-year-old intact male mini lop rabbit (Oryctolagus cuniculus) was presented with a 2-week history of severe progressive lethargy. A right parasternal continuous heart murmur and an irregular rhythm were detected on physical examination. Echocardiography identified vegetative aortic and tricuspid valve (TV) endocarditis. There was an aortocavitary fistula between the right sinus of Valsalva into the right ventricle, creating a left-to-right intracardiac shunt. Based on the echocardiographic findings, it was suspected that the infection originated in the aortic valve, eroded through the periannular tissue, and secondarily infected the TV. Pleural and peritoneal effusion secondary to right-sided congestive heart failure was also found during the echocardiogram. Atrial fibrillation, conducted with a left bundle branch block morphology, was identified using electrocardiography. Necropsy findings directly correlated with the echocardiographic diagnosis; marked periodontal disease was also identified. Aerobic culture of the aortic and tricuspid vegetations resulted in significant growth of Haemophilus parainfluenzae. Haemophilus spp. belong to a group of similar gram-negative coccobacillus bacteria (HACEK group), which can act as an uncommon cause of endocarditis in humans. HACEK endocarditis is most commonly associated with oral infection and/or dental procedures in people. This is the first case report of a rabbit with periannular complications of infective endocarditis. It remains unknown whether dental disease resulted in endocarditis in this patient.
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11
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Banga S, Barzallo MA, Nighswonger CL, Mungee S. Transcatheter aortic valve replacement in membranous interventricular septum aneurysm with left ventricular outflow tract extension. World J Cardiol 2018; 10:1-5. [PMID: 29391929 PMCID: PMC5785698 DOI: 10.4330/wjc.v10.i1.1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2017] [Revised: 12/25/2017] [Accepted: 01/16/2018] [Indexed: 02/06/2023] Open
Abstract
We report a challenging case of a 81-year-old male with history of severe calcific aortic valve stenosis and aneurysmal membranous interventricular septum. The presence of anomalies in the sub-annular area can lead to valve malpositioning and its consequences. Transcatheter aortic valve implantation (TAVR) in patients with aneurysm of the perimembranous interventricular septum extending into the left ventricular outflow tract has not been previously reported. This case describes a successful transfemoral TAVR with an Edwards SAPIEN XT valve (Edwards Lifesciences, Irvine, CA, United States) with such anomaly.
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Affiliation(s)
- Sandeep Banga
- Division of Cardiology, Department of Internal Medicine, University of Illinois College of Medicine at Peoria, Peoria, IL 61637, United States
- Osf St. Francis Medical Center, Peoria, IL 61637, United States
| | - Marco A Barzallo
- Division of Cardiology, Department of Internal Medicine, University of Illinois College of Medicine at Peoria, Peoria, IL 61637, United States
- Osf St. Francis Medical Center, Peoria, IL 61637, United States
| | | | - Sudhir Mungee
- Division of Cardiology, Department of Internal Medicine, University of Illinois College of Medicine at Peoria, Peoria, IL 61637, United States
- Osf St. Francis Medical Center, Peoria, IL 61637, United States
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12
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Wang K, Wang X, Yu H, Liu X, Xing A, You Y. A single-center experience with 12 consecutive cases of pregnancy among patients with membranous ventricular septal aneurysm. BMC Pregnancy Childbirth 2018; 18:8. [PMID: 29298686 PMCID: PMC5751772 DOI: 10.1186/s12884-017-1646-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2016] [Accepted: 12/21/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Membranous ventricular septal aneurysm (MVSA) is a rare cardiac anomaly that can occur as an isolated entity or being associated with other cardiac malformations. Complications of MVSA include thromboembolism, arrhythmia, rupture, bacterial endocarditis, right ventricular outflow tract obstruction, and atrioventricular valve diseases.The success rate of pregnancy and delivery in patients with MVSA has not been reported in the literature. This study was to assess the clinical implications of this condition from our center's experience. METHODS This was a retrospective study for consecutive 12 pregnancies in women with MVSA, who delivered at a tertiary care center in west China between May 2008 and March 2015. RESULTS All patients with MVSA delivered via caesarian section. One patient with severe pulmonary arterial hypertension expired from pulmonary infection and heart failure after delivery. One patient terminated pregnancy in the second trimester- necessitated by cardiogenic shock. The other mothers had varying degrees of cardiac morbidity, but survived. Ten of thirteen newborns survived. Congenital heart disease and small-for-gestational-age (SGA) of newborn occurred in two cases (one twin and one single gestation). Two of these babies expired. CONCLUSIONS Maternal and neonatal risk appeared associated with heart functional classifications, pulmonary hypertension and histories of cardiac events such as serious cardiac arrhythmia. Accurate diagnosis and care by a multidisciplinary team is recommended for pregnant woman with MVSA.
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Affiliation(s)
- Kana Wang
- Department of Obstetrics and Gynecology, West China Second University Hospital, Sichuan University, Chengdu, China.,Key Laboratory of Birth Defects and Related Diseases of Women and Children, (Sichuan University), Ministry of Education, Chengdu, China
| | - Xiaodong Wang
- Department of Obstetrics and Gynecology, West China Second University Hospital, Sichuan University, Chengdu, China.,Key Laboratory of Birth Defects and Related Diseases of Women and Children, (Sichuan University), Ministry of Education, Chengdu, China
| | - Haiyan Yu
- Department of Obstetrics and Gynecology, West China Second University Hospital, Sichuan University, Chengdu, China. .,Key Laboratory of Birth Defects and Related Diseases of Women and Children, (Sichuan University), Ministry of Education, Chengdu, China.
| | - Xinghui Liu
- Department of Obstetrics and Gynecology, West China Second University Hospital, Sichuan University, Chengdu, China.,Key Laboratory of Birth Defects and Related Diseases of Women and Children, (Sichuan University), Ministry of Education, Chengdu, China
| | - Aiyun Xing
- Department of Obstetrics and Gynecology, West China Second University Hospital, Sichuan University, Chengdu, China.,Key Laboratory of Birth Defects and Related Diseases of Women and Children, (Sichuan University), Ministry of Education, Chengdu, China
| | - Yong You
- Department of Obstetrics and Gynecology, West China Second University Hospital, Sichuan University, Chengdu, China.,Key Laboratory of Birth Defects and Related Diseases of Women and Children, (Sichuan University), Ministry of Education, Chengdu, China
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13
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Privitera F, Monte IP, Indelicato A, Tamburino C. A Membranous Septal Aneurysm Causing Right Ventricular Outflow Tract Obstruction in an Adult. J Cardiovasc Echogr 2017; 27:145-148. [PMID: 29142814 PMCID: PMC5672688 DOI: 10.4103/jcecho.jcecho_21_17] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
We describe a case of a 69-year-old female referred for the evaluation of exertional dyspnea, with a small membranous ventricular septal defect (VSD) and right ventricle (RV) outflow tract obstruction. Using transthoracic echo was diagnosed VSD with left to right shunting and transesophageal echo (TEE) was used to a better anatomical characterization. TEE showed a perimembranous subaortic VSD that developed a high-velocity flow in RV. Pulmonary valve appears normal and right ventricular infundibular hypertrophy or double-chambered RV was excluded from the study. Furthermore, TEE showed a malaligned VSD and the presence of perimembranous mobile tissue protruding in RV. We hypothesized that this tissue can be attributed to broken septum aneurysm and protruding during systole, it causes a dynamic RV output tract obstruction.
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Affiliation(s)
- Fiorella Privitera
- Department of General Surgery and Medical-Surgery Specialities, University of Catania, Catania CT, Italy
| | - Ines Paola Monte
- Department of General Surgery and Medical-Surgery Specialities, University of Catania, Catania CT, Italy.,Department of Cardio-Thorax-Vascular and Transplant, A.O.U. Policlinico Catania, Catania CT, Italy
| | - Antonino Indelicato
- Department of Cardio-Thorax-Vascular and Transplant, A.O.U. Policlinico Catania, Catania CT, Italy
| | - Corrado Tamburino
- Department of General Surgery and Medical-Surgery Specialities, University of Catania, Catania CT, Italy.,Department of Cardio-Thorax-Vascular and Transplant, A.O.U. Policlinico Catania, Catania CT, Italy
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14
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Cooper TK. Membranous ventricular septal aneurysm in a black-tailed prairie dog ( Cynomys ludovicianus). J Vet Diagn Invest 2017; 29:583-585. [PMID: 28548023 DOI: 10.1177/1040638717710236] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Ventricular septal defects are one of the most common congenital cardiac malformations in animals, and most often affect the membranous portion of the septum. These defects may rarely close spontaneously. An adult male black-tailed prairie dog ( Cynomys ludovicianus) had a smooth shiny botryoid red mass arising from the area of the septal cusp of the right atrioventricular (tricuspid) valve and membranous interventricular septum, and bulging into the right ventricular lumen. Histology and special staining demonstrated a membranous ventricular septal defect closed by the adherence of the septal cusp of the tricuspid valve to the muscular septum (so-called membranous ventricular septal aneurysm or aneurysm of the [peri]membranous ventricular septum). This is a rare finding in animals, and the histologic appearance has not been documented previously, to our knowledge.
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Affiliation(s)
- Timothy K Cooper
- Departments of Comparative Medicine and Pathology, Penn State College of Medicine, Penn State Hershey Medical Center, Hershey, PA
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15
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Abdul Jabbar A, Mufti O, Mazur W, Quraishi MB, Srivastava BK, Tivakaran V. Isolated Aneurysms of the Membranous Ventricular Septum Without Residual Shunts: Systematic Review and Description of 3 Cases in Adults. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2017; 36:869-878. [PMID: 28230264 DOI: 10.7863/ultra.16.02087] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/04/2016] [Accepted: 07/28/2016] [Indexed: 06/06/2023]
Abstract
A ventricular septal defect is the most common congenital cardiac abnormality encountered in infants and children. Many of them survive through adulthood before diagnosis. Two-thirds of the cases involve the membranous part of the septum. In the absence of an interventricular shunt or concomitant cardiac surgery, guidelines for surgical intervention or resection of isolated aneurysms of the membranous septum are not well established. In this report, we discuss a multi-imaging modality approach for the diagnosis and assessment of membranous ventricular septal aneurysms and review the experts' consensuses for follow-up and treatment strategies.
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Affiliation(s)
- Ali Abdul Jabbar
- Department of Internal Medicine, Division of Cardiology, Wright State University Boonshoft School of Medicine, Dayton, Ohio, USA
- Department of Cardiovascular Medicine, University of Toledo Health Science Campus, Toledo, Ohio, USA
| | - Omar Mufti
- Department of Internal Medicine, Division of Cardiology, Wright State University Boonshoft School of Medicine, Dayton, Ohio, USA
| | - Wojciech Mazur
- Department of Cardiology, Christ Hospital, Cincinnati, Ohio, USA
| | | | - Bal K Srivastava
- Department of Internal Medicine, Division of Cardiology, Wright State University Boonshoft School of Medicine, Dayton, Ohio, USA
| | - Vijay Tivakaran
- Department of Cardiology, Dayton VA Medical Center, Dayton, Ohio, USA
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Sharma M, Elmi F. Interventricular Membranous Septal Aneurysm Incidentally Diagnosed During Computed Tomographic Angiography in a Patient with Infrequent Supraventricular Tachycardia. Clin Pract 2017; 7:921. [PMID: 28243432 PMCID: PMC5264550 DOI: 10.4081/cp.2017.921] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2016] [Accepted: 11/30/2016] [Indexed: 12/27/2022] Open
Abstract
Interventricular membranous septal (IVMS) aneurysm is a rare condition with no accurate incidence. It is known to be associated with 0.3 % of congenital heart disease and 19 % of ventricular septal defects. IVMS aneurysm is often asymptomatic but can be complicated with right ventricular obstruction, rupture, thromboembolism, and conduction defects. Clinicians and radiologist should be aware about this rare clinical entity and evaluation of any possible underlying cardiac abnormalities should be performed. Conservative management with close follow up is the mainstay of management in the absence of complication.
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Affiliation(s)
- Munish Sharma
- Department of Internal Medicine, Easton Hospital , Easton, PA
| | - Farhad Elmi
- Department of Cardiology, Easton Hospital and Drexel University College of Medicine , Easton, PA, USA
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17
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Martínez-Quintana E, Rodríguez-González F. Aneurisma del septo membranoso ventricular: ser o no ser. Rev Esp Cardiol (Engl Ed) 2016. [DOI: 10.1016/j.recesp.2016.02.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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18
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Martínez-Quintana E, Rodríguez-González F. Membranous Ventricular Septal Aneurysm: to Be or not to Be. REVISTA ESPANOLA DE CARDIOLOGIA (ENGLISH ED.) 2016; 69:634. [PMID: 27131974 DOI: 10.1016/j.rec.2016.02.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/12/2016] [Accepted: 02/19/2016] [Indexed: 06/05/2023]
Affiliation(s)
- Efrén Martínez-Quintana
- Servicio de Cardiología, Complejo Hospitalario Universitario Insular-Materno Infantil, Universidad de Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Spain.
| | - Fayna Rodríguez-González
- Servicio de Oftalmología, Hospital Universitario de Gran Canaria Doctor Negrín, Las Palmas de Gran Canaria, Spain
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19
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Carcano C, Kanne JP, Kirsch J. Interventricular membranous septal aneurysm: CT and MR manifestations. Insights Imaging 2015; 7:111-7. [PMID: 26687514 PMCID: PMC4729708 DOI: 10.1007/s13244-015-0456-3] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2015] [Revised: 11/28/2015] [Accepted: 12/01/2015] [Indexed: 12/27/2022] Open
Abstract
Advanced cardiac imaging is a valuable method to investigate cardiac malformations. The detection of the interventricular membranous septum has clinical significance due to thrombogenic and arrythmogenic predisposition, as well as a role in obstructing the pulmonary flow. This review describes six clinical presentations in which advanced cardiac imaging has been the tool for evaluation, with special emphasis in CT angiography and cardiac MRI sequences. Teaching Points • The interventricular membranous septum can predispose patients to thrombogenic and arrythmogenic events. • Subpulmonic stenosis relates to the protrusion of the aneurysm into the right ventricle • During surgery, ventricular pressures of the opened heart become balanced, making the aneurysm less evident.
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Affiliation(s)
- Carolina Carcano
- Department of Radiology, Cleveland Clinic Florida, 2950 Cleveland Clinic Blvd, Weston, Fl, 33331, USA. .,Department of Radiology, Mount Sinai Medical center, 4300 Alton Road, Miami Beach, FL, 33141, USA.
| | - Jeffrey P Kanne
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, 750 Highland Avenue, Madison, WI, 53726, USA.
| | - Jacobo Kirsch
- Department of Radiology, Cleveland Clinic Florida, 2950 Cleveland Clinic Blvd, Weston, Fl, 33331, USA.
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20
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Silva-Rojas S, Martínez-Marín M, Moreno-Esteban EM. Aneurisma del septo interventricular membranoso. ¿Qué hacer con él? REVISTA COLOMBIANA DE CARDIOLOGÍA 2015. [DOI: 10.1016/j.rccar.2015.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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21
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Bai Y, Liu J, Qin YW, Wu H, Zhao XX. Percutaneous Closure of Perimembranous Ventricular Septal Defect with Modified Double-disk Occluder: What Is the Outcome at 10-year Follow-up? CONGENIT HEART DIS 2015; 11:45-51. [PMID: 26171994 DOI: 10.1111/chd.12284] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/26/2015] [Indexed: 12/01/2022]
Abstract
OBJECTIVE Percutaneous closure of perimembranous ventricular septal defect is one of the greatest challenges in interventional cardiology. The long-term follow-up data are still limited. This report presents our experience in percutaneous closure of perimembranous ventricular septal defect with modified double-disk occluder. DESIGN The study is a retrospective analysis of cases from the Changhai Hospital clinic database. SETTING We reviewed the clinic database from December 2001 to December 2005. PATIENTS We included 117 patients who underwent percutaneous closure of perimembranous ventricular septal defects. OUTCOME MEASURES Procedural data and complications were assessed by an expert panel of cardiologists. RESULTS Device implantation was successfully accomplished in 113 of a total 117 patients (96.6%). The mean age was 31.1 ± 12.5 years (range 2-56 years). The patients were followed for a period of 86-134 months. The diameter of defect was 2-15 mm (mean 4.9 ± 2.9 mm). The ventricular septal defect rim below the aortic valve was 1-5 mm. The mean diameter of device used was 6.9 ± 3.7 (range 4-24 mm). Four patients presented complete atrio-ventricular block within 1 week after the procedure and recovered within 3 weeks. No other patient encountered serious adverse events during the follow-up. CONCLUSIONS Percutaneous closure of ventricular septal defect is safe and effective in most selected patients with modified double-disk occluder. Additional studies with larger cohorts and longer follow-up are needed to evaluate its safety.
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Affiliation(s)
- Yuan Bai
- Department of Cardiology, Changhai Hospital, The Second Military Medical University, Shanghai, China
| | - Jing Liu
- Department of Cardiology, Changhai Hospital, The Second Military Medical University, Shanghai, China
| | - Yong-Wen Qin
- Department of Cardiology, Changhai Hospital, The Second Military Medical University, Shanghai, China
| | - Hong Wu
- Department of Cardiology, Changhai Hospital, The Second Military Medical University, Shanghai, China
| | - Xian-Xian Zhao
- Department of Cardiology, Changhai Hospital, The Second Military Medical University, Shanghai, China
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22
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Murphy TM, Waterhouse DF, Maher V, O'Hanlon R. CMR detection of membraneous ventricular septal aneurysm causing ventricular tachycardia. Diagn Interv Imaging 2015; 96:963-4. [PMID: 25920688 DOI: 10.1016/j.diii.2014.12.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2014] [Revised: 12/21/2014] [Accepted: 12/22/2014] [Indexed: 11/27/2022]
Affiliation(s)
- T M Murphy
- Blackrock Clinic, Center for Cardiovascular Magnetic Resonance, Rock Road, Dublin, Ireland.
| | - D F Waterhouse
- Blackrock Clinic, Center for Cardiovascular Magnetic Resonance, Rock Road, Dublin, Ireland
| | - V Maher
- Blackrock Clinic, Center for Cardiovascular Magnetic Resonance, Rock Road, Dublin, Ireland
| | - R O'Hanlon
- Blackrock Clinic, Center for Cardiovascular Magnetic Resonance, Rock Road, Dublin, Ireland
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23
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You JY, Chun EJ, Choi SI, Joe E, Lee W, Kang JW, Seo MK, Yoon YE, Oh IY, Kim E, Lim TH. Clinical significance of incidentally detected aneurysms of the membranous ventricular septum in adults by multidetector computed tomography. Am J Cardiol 2015; 115:354-9. [PMID: 25491239 DOI: 10.1016/j.amjcard.2014.11.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2014] [Revised: 11/01/2014] [Accepted: 11/01/2014] [Indexed: 11/15/2022]
Abstract
Although the clinical relevance of aneurysm of the membranous ventricular septum (AMVS) in adults is unclear, the frequency of AMVS detection has been increased because cardiac multidetector computed tomography has been widely adopted for the evaluation of coronary artery disease. Therefore, we aimed to assess the clinical significance of AMVS in a longitudinal study. In 30,120 adults with suspected coronary artery disease who underwent cardiac multidetector computed tomography in 3 hospitals, 52 patients with AMVS were retrospectively selected. We evaluated the clinical symptoms and electrocardiographic abnormalities (cross-sectional study) and the prevalence of embolic stroke (observational study) during a median 40-month (range 6 to 74 months) observation period. For the assessment of embolic stroke, we excluded 9 patients with other explainable embolic sources. Conduction abnormalities were noted in 13 of 52 adults (25%) with AMVS on electrocardiography and embolic stroke occurred in 6 of 43 patients (14%). The mean age and the prevalence of hypertension were significantly higher in the embolic stroke group than in the event-free group (p <0.05). Thrombi were detected in the 11.6% of AMVS, which was significantly related with embolic stroke (p <0.05). The size and morphology did not change in 15 patients with serial follow-up images. In conclusion, our study suggests that AMVS in adults should not be ignored because AMVS may be related to conduction abnormality or embolic stroke, and it does not spontaneously resolve or diminish in size.
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Affiliation(s)
- Ja Yeon You
- Department of Radiology, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggido, Korea
| | - Eun Ju Chun
- Department of Radiology, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggido, Korea.
| | - Sang Il Choi
- Department of Radiology, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggido, Korea
| | - Eugene Joe
- Department of Radiology, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggido, Korea
| | - Whal Lee
- Department of Radiology, Seoul National University Hospital, Seoul, Korea
| | - Joon-Won Kang
- Department of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Myung-Ki Seo
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Yeonyee E Yoon
- Department of Internal Medicine and Cardiovascular Center, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggido, Korea
| | - Il-Young Oh
- Department of Internal Medicine and Cardiovascular Center, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggido, Korea
| | - Eunhee Kim
- Department of Radiology, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggido, Korea
| | - Tae-Hwan Lim
- Department of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
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24
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Karagöz A, Çelik A, Vural A, Başer B. An incidentally detected giant membranous interventricular septal aneurysm secondary to previous surgery for subaortic valvular stenosis. BMJ Case Rep 2014; 2014:bcr-2014-206331. [PMID: 25240004 DOI: 10.1136/bcr-2014-206331] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Ventricular septal aneurysms are rare clinical entities and their certain prevalence and clinical significance are not well known. Most of them are thought to develop during or after the closure process of the accompanying ventricular septal defects. Although a majority of the patients are typically asymptomatic, the potential risks should also be kept in mind. We present a case of a membranous interventricular septal aneurysm that developed after surgery for subaortic valvular stenosis. The points that make our case worth reporting are development of the aneurysm after aortic surgery and lack of a concomitant ventricular septal defect. On the basis of the existence of an aortic valve surgery history and reports that do not mention any ventricular septal defect and ventricular septal aneurysm when she was operated, we suggest that the aneurysmatic formation in the membranous portion of the interventricular septum developed due to valve surgery in the postoperative wound healing period.
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Affiliation(s)
- Ahmet Karagöz
- Department of Cardiology, Giresun University, Giresun, Turkey
| | - Abdullah Çelik
- Department of Cardiovascular Surgery, Giresun University, Giresun, Turkey
| | - Aslı Vural
- Department of Cardiology, Giresun University, Giresun, Turkey
| | - Bengi Başer
- Department of Cardiology, Giresun University, Giresun, Turkey
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25
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Di Cesare E, Di Sibio A, Lanni G, Gennarelli A, Masciocchi C. Magnetic resonance imaging of AMS (Aneurysm of the Membranous Septum), review of the literature and case report. J Radiol Case Rep 2014; 8:9-15. [PMID: 25426225 DOI: 10.3941/jrcr.v8i5.1715] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Aneurysm of the Membranous Septum (AMS) is a rare cardiac disease, mostly associated with other cardiac anomalies, very rare in the absence of other congenital heart defects. A prompt diagnosis is important, due to severe potential complications, but remain challenging. Most of the cases were earlier diagnosed using ventriculography, but, with the availability of echocardiography and cardiovascular magnetic resonance (CMR), this disease can be accurately assessed non-invasively. We report a case of a 62 years old female patient, without other cardiac congenital disease, who was incidentally diagnosed, by means of CMR with a true and isolated AMS. Our report underlines CMR usefulness in AMS diagnosis, thanks to accurate evaluation (both morphologic and functional) provided by this diagnostic tool, which is able to demonstrate clearly the presence of AMS (aneurysm of the membranous septum) and depict its features.
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26
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Zhou K, Hua Y, Qiao L. A case of late-onset sustained ventricular tachycardia following deployment of Amplatzer-type perimembranous VSD occluder. Catheter Cardiovasc Interv 2013; 83:256-60. [PMID: 22927019 DOI: 10.1002/ccd.24627] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2011] [Accepted: 08/20/2012] [Indexed: 11/09/2022]
Abstract
Transcatheter closure of ventricular septal defect (VSD) has been widely used worldwide. Despite high success rate and minimal operative mortality, arrhythmia during and post-operation has been frequently observed. However, sustained ventricular tachycardia following deployment of occluder has not been reported. In this present case, we present one rare case of late-onset sustained ventricular tachycardia, which developed 71 hr after deployment of an Amplatzer-type occluder for perimembranous VSD (PmVSD) in a 3-year and 5-month-old boy. The sustained ventricular tachycardia was successfully corrected with the administration of lidocaine, amiodarone, and dexamethasone. The reoccurrence of ventricular tachycardia was not observed in the most recent follow-up at 6 month. In summary, the current case indicated that sustained ventricular tachycardia could occur following deployment of Amplatzer-type occluder for PmVSD, which could be corrected with antiarrhythmic drugs.
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Affiliation(s)
- Kaiyu Zhou
- Department of Pediatric Cardiology, Sichuan University, Chengdu, 610041, China; Key Laboratory of Obstetric & Gynecologic and Pediatric Diseases and Birth Defects of Ministry of Education, Sichuan University, Chengdu, 610041, China; Yangtze River Scholars Program and Innovative Research Team in University, West China Second University Hospital and West China School of Medicine, Sichuan University, Chengdu, 610041, China
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27
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Abbag F. The natural history of ventricular septal defects in the south-western region of Saudi Arabia. ACTA ACUST UNITED AC 2013; 26:215-8. [PMID: 16925958 DOI: 10.1179/146532806x120309] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
AIM To determine the natural history and spontaneous closure (SpC) of ventricular septal defect (VSD) in a cohort of patients. METHODS Using echocardiography, 86 patients with VSD were followed up for 1-168 mths (mean 66.3, SD 46.0). RESULTS Mean age at diagnosis was 14 mths, 26 patients were diagnosed at < or = 1 mth (group 1) and 60 later (group 2). Types of VSD were: peri-membranous (PM-VSD) 67.4%, muscular (MU-VSD) 19.8%, inlet 7% and subpulmonary/subarterial 5.8%. SpC occurred in 16.3% of the whole group, 34.6% of group 1 and 8.3% of group 2 (p = 0.002). SpC occurred only in PM-VSDs (19%) and in MU-VSDs (17.6%). It occurred in 26.5% of the small VSDs and in none of the large VSDs. One patient (1.2%) developed endocarditis and another pulmonary vascular disease. CONCLUSIONS PM-VSD was the most common type of VSD. SpC is age-dependent, occurring mainly in PM and MU-VSDs. SpC of a large VSD is unusual.
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Affiliation(s)
- Fuad Abbag
- Department of Child Health, College of Medicine, King Khalid University, Abha, Kingdom of Saudi Arabia.
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28
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Stendahl JC, Hasan AS, Simegn MA. Massive interventricular septal aneurysm and stroke in a healthy young patient: guilt by association? J Stroke Cerebrovasc Dis 2013; 23:590-1. [PMID: 23747177 DOI: 10.1016/j.jstrokecerebrovasdis.2013.05.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2013] [Accepted: 05/06/2013] [Indexed: 10/26/2022] Open
Abstract
Aneurysm of the membranous interventricular septum is an uncommon cardiac defect that is, on rare occasions, associated with embolic stroke. We describe here the case of an otherwise healthy, 41-year-old man who presented to the hospital with acute-onset confusion and left-sided body weakness attributed to a right middle cerebral artery ischemic stroke. He experienced a nearly complete resolution of deficits following systemic thrombolytic therapy. After an extensive workup, the presumed mechanism of stroke was a thromboembolus that originated in a massive aneurysm of the patient's membranous interventricular septum. Due to a perceived risk of surgical morbidity, the patient was managed conservatively with anticoagulation. He denied further events and reported nearly full function at follow-up.
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Affiliation(s)
- John C Stendahl
- Department of Medicine, Hennepin County Medical Center, Minneapolis, Minnesota.
| | - Amatul S Hasan
- Department of Medicine, Hennepin County Medical Center, Minneapolis, Minnesota; Division of Cardiology, Hennepin County Medical Center, Minneapolis, Minnesota; Division of Cardiology, Department of Medicine, Abbott Northwestern Hospital, Minneapolis, Minnesota
| | - Mengistu A Simegn
- Department of Medicine, Hennepin County Medical Center, Minneapolis, Minnesota; Division of Cardiology, Hennepin County Medical Center, Minneapolis, Minnesota; Department of Medicine, University of Minnesota, Minneapolis, Minnesota
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29
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Cozijnsen MA, Cozijnsen L, Maas ACP, Bakker-de Boo M, Bouma BJ. A ventricular septal defect with a giant appendiform aneurysm of the membranous septum. Neth Heart J 2013; 21:152-4. [PMID: 23229810 DOI: 10.1007/s12471-012-0343-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
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.
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Affiliation(s)
- M A Cozijnsen
- Department of Cardiology, Gelre Hospital, Albert Schweitzerlaan 31, 7334 DZ, Apeldoorn, the Netherlands
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30
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Jin Y, Han B, Zhang J, Zhuang J, Yan J, Wang Y. Postimplant complications with transcatheter closure of congenital perimembranous ventricular septal defects: a single-center, longitudinal study from 2002 to 2011. Catheter Cardiovasc Interv 2013; 81:666-73. [PMID: 22936471 DOI: 10.1002/ccd.24638] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2012] [Accepted: 08/26/2012] [Indexed: 11/09/2022]
Abstract
BACKGROUND Whether or not to close perimembranous VSDs (pmVSDs) by transcatheter techniques is controversial because of a high rate of complications as compared with surgical alternatives. OBJECTIVE We report the short- and long-term follow-up results of the use of several kinds of devices to close pmVSDs and the annual incidence of postimplant complications in our center. METHODS From June 2002 to June 2011, 232 patients with pmVSD underwent attempted transcatheter closure; closure was successful in 209 cases (90.1%). Six types of occlusive devices were used. Patient age, defect size, device type, device size and its relation to defect size, and transcatheter and fluoroscopy time were analyzed for correlation with annual incidence of postimplant complications. RESULTS There were no deaths during the follow-up period. Within 1 month after transcatheter closure, we found 91 adverse events (43.5%), but only 32 cases showed a trace amount of residual shunting. From 2002 to 2011, the annual incidence of postimplant complications gradually decreased, from 50% in 2002 to 17.6% in 2011. The use of Amplatzer occluder devices (r = 0.71, P = 0.033), double-disc symmetrical occluder devices (r = -0.68, P = 0.045), and transcatheter (r = 0.87, P = 0.003), and fluoroscopy time (r = 0.78, P = 0.02) were significantly correlated with the incidence of post-implant complications. CONCLUSIONS Results of transcatheter closure of pmVSD in terms of postimplant complications are encouraging in our center. It seemed that eccentric Amplatzer and domestic occluder may be at rather higher risk for postimplant complications. The incidence of postimplant complications may be minimized by skilled maneuvers, excluding rather small patients, and selecting the appropriate kind of occlusive device.
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Affiliation(s)
- Youpeng Jin
- Pediatric Department, Provincial Hospital Affiliated to Shandong University, Shandong, China
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31
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Horne D, White CW, Mackenzie GS, Kirkpatrick IDC, Freed DH. Adult presentation with a bilobed membranous ventricular septal aneurysm. Can J Cardiol 2013; 29:893.e1-3. [PMID: 23333163 DOI: 10.1016/j.cjca.2012.11.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2012] [Revised: 10/21/2012] [Accepted: 11/03/2012] [Indexed: 11/29/2022] Open
Abstract
Membranous ventricular septum aneurysm (MVSA) is an uncommon cardiac abnormality primarily associated with the spontaneous closure of a small membranous ventricular septal defect in childhood. Diagnosis of an idiopathic MVSA in an adult is exceedingly rare. We report on a man, aged 38 years, with a bilobed MVSA diagnosed by transesophageal echocardiography and gated computed tomography, with separate aneurysm sacs extending into the right atrium and right ventricle.
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Affiliation(s)
- David Horne
- Department of Surgery, University of Manitoba, Winnipeg, Manitoba, Canada.
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32
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Dilawar M, Ahmad Z. Safety and efficacy of amplatzer duct occluder for percutaneous closure of ventricular septal defects with tunnel shape aneurysm: Medium term follow up. ACTA ACUST UNITED AC 2013. [DOI: 10.4236/wjcd.2013.32035] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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33
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Incidental discovery of a membranous ventricular septal aneurysm in two dissimilar patients. Case Rep Cardiol 2012; 2012:324326. [PMID: 24826245 PMCID: PMC4008397 DOI: 10.1155/2012/324326] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2012] [Accepted: 09/09/2012] [Indexed: 12/21/2022] Open
Abstract
A ventricular septal aneurysm (VSA) is a rare cardiac anomaly, and an accurate statistic of its prevalence has not been reported in the literature. True incidence is likely underestimated as most patients are thought to be asymptomatic. As a result, most VSAs are discovered incidentally on echocardiography, during angiography, or at autopsy. Potential complications include rupture, bacterial endocarditis, right ventricular outflow tract obstruction, and thromboembolic disease. It has been proposed that VSAs occur in association with ventricular septal defects (VSDs) and other congenital cardiac abnormalities. It is uncommon for a VSA to exist in the absence of a known prior ventricular septal defect. We present two cases, each highlighting an incidental intact aneurysm involving the membranous interventricular septum. We discuss the contrast in the two patients with regard to their age, accompanying cardiac anomalies and cardiovascular fitness. Clinical implications of the condition are reviewed.
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34
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Fabijanic D, Bulat C, Batinic T, Carevic V, Caljkusic K. Membranous ventricular septum aneurysm as a cause of recurrent transient ischemic attack. J Cardiovasc Ultrasound 2012; 20:114-5. [PMID: 22787532 PMCID: PMC3391629 DOI: 10.4250/jcu.2012.20.2.114] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2012] [Revised: 04/27/2012] [Accepted: 05/15/2012] [Indexed: 11/22/2022] Open
Affiliation(s)
- Damir Fabijanic
- Division of Cardiology, Split Clinical Hospital Centre, Split, Croatia
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35
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Erol C, Koplay M, Olcay A, Kivrak AS, Ozbek S, Seker M, Paksoy Y. Congenital left ventricular wall abnormalities in adults detected by gated cardiac multidetector computed tomography: clefts, aneurysms, diverticula and terminology problems. Eur J Radiol 2012; 81:3276-81. [PMID: 22534466 DOI: 10.1016/j.ejrad.2012.03.025] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2012] [Revised: 03/28/2012] [Accepted: 03/31/2012] [Indexed: 10/28/2022]
Abstract
OBJECTIVES Our aim was to evaluate congenital left ventricular wall abnormalities (clefts, aneurysms and diverticula), describe and illustrate imaging features, discuss terminology problems and determine their prevalence detected by cardiac CT in a single center. MATERIALS AND METHODS Coronary CT angiography images of 2093 adult patients were evaluated retrospectively in order to determine congenital left ventricular wall abnormalities. RESULTS The incidence of left ventricular clefts (LVC) was 6.7% (141 patients) and statistically significant difference was not detected between the sexes regarding LVC (P=0.5). LVCs were single in 65.2% and multiple in 34.8% of patients. They were located at the basal to mid inferoseptal segment of the left ventricle in 55.4%, the basal to mid anteroseptal segment in 24.1%, basal to mid inferior segment in 17% and septal-apical septal segment in 3.5% of cases. The cleft length ranged from 5 to 22 mm (mean 10.5 mm) and they had a narrow connection with the left ventricle (mean 2.5 mm). They were contractile with the left ventricle and obliterated during systole. Congenital left ventricular septal aneurysm that was located just under the aortic valve was detected in two patients (0.1%). No case of congenital left ventricular diverticulum was detected. CONCLUSION Cardiac CT allows us to recognize congenital left ventricular wall abnormalities which have been previously overlooked in adults. LVC is a congenital structural variant of the myocardium, is seen more frequently than previously reported and should be differentiated from aneurysm and diverticulum for possible catastrophic complications of the latter two.
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Affiliation(s)
- Cengiz Erol
- Selcuk University, Selcuklu Faculty of Medicine, Department of Radiology, Alaeddin Keykubat Central Campus, Selcuklu, 42250 Konya, Turkey.
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Inan BK, Ucak A, Temizkan V, Guler A, Ak K, Ugur M, Alp I, Arslan G, Yilmaz AT. Natural internal banding in adult patients with a large ventricular septal defect and a preserved pulmonary vascular system. Heart Surg Forum 2011; 14:E202-6. [PMID: 21676691 DOI: 10.1532/hsf98.20091154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE Hypertrophied anomalous muscle bands (AMBs) in the right ventricular outflow tract (RVOT) may develop in the context of ventricular septal defects (VSDs) and limit persistent pulmonary overflow. In adult patients with a large VSD, persistent AMBs in the RVOT therefore can simulate the role of an externally placed pulmonary artery band. We termed such alterations natural internal bands (NIBs). Our goal was to establish the morphologic nature of the obstructive muscular lesions of the RVOT in patients with a large VSD. METHODS Patients who underwent operations for a large VSD in our center, which has a high volume of adult patients with congenital defects, were retrospectively reviewed, and the nature of the NIBs in these patients was documented. All patients underwent transthoracic echocardiography and cardiac catheterization evaluations preoperatively and at postoperative month 3. Histopathologic examination of the AMBs was performed. RESULTS Of 96 adult patients who underwent operations for a large isolated VSD (mean defect size, 16.9 ± 3.5 mm), 16 patients had a hemodynamically significant NIB. Two different patterns of obstruction were found. Ten of the 16 patients revealed an os infundibulum morphology, and 6 patients revealed systolic bulging of the conal septum. Four of the patients with os infundibulum also had classic tetralogy-type septal malalignment. The mean peak systolic gradient on the RVOT was 56.5 ± 17.2 mm Hg and 53.6 ± 12.3 mm Hg in the patients with os infundibulum and in the patients with systolic bulging of the conal septum, respectively. Surgical repair of the VSD was completed successfully in all patients. Resection of the os infundibulum was performed concomitantly in patients with os infundibulum. At the third postoperative month, the mean peak systolic gradient was 16.8 ± 3.5 mm Hg in patients with os infundibulum and 26 ± 5.9 mm Hg (range, 20-35 mm Hg) in patients with systolic septal bulging. CONCLUSIONS Some mechanisms in adult type VSDs are essential for protecting the pulmonary vasculature. We tried to review these protective mechanisms: hypertrophied AMBs and NIBs.
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Affiliation(s)
- Bilal Kaan Inan
- Gülhane Military Medical Academy Haydarpasa Teaching Hospital, Cardiovascular Surgery Clinic, Istanbul, Turkey.
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Shambrook J, Chowdhury R, Brown I, Peebles C, Harden S. Cross-sectional imaging appearances of cardiac aneurysms. Clin Radiol 2010; 65:349-57. [DOI: 10.1016/j.crad.2010.02.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2009] [Revised: 02/09/2010] [Accepted: 02/14/2010] [Indexed: 11/26/2022]
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Inan K, Ucak A, Temizkan V, Ak K, Sen H, Yilmaz AT. Pulmonary Vascular Protective Mechanisms in Adult Patients with an Isolated Large Ventricular Septal Defect: A 21‐Year Experience. J Card Surg 2009; 24:742-7. [DOI: 10.1111/j.1540-8191.2009.00913.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Kaan Inan
- GATA Haydarpasa Training Hospital, Cardiovascular Surgery, Cardiovascular Surgery Clinic, Istanbul, Turkey; †GATA Haydarpasa Training Hospital Anesthesiology, Istanbul, Turkey
| | - Alper Ucak
- GATA Haydarpasa Training Hospital, Cardiovascular Surgery, Cardiovascular Surgery Clinic, Istanbul, Turkey; †GATA Haydarpasa Training Hospital Anesthesiology, Istanbul, Turkey
| | - Veysel Temizkan
- GATA Haydarpasa Training Hospital, Cardiovascular Surgery, Cardiovascular Surgery Clinic, Istanbul, Turkey; †GATA Haydarpasa Training Hospital Anesthesiology, Istanbul, Turkey
| | - Koray Ak
- GATA Haydarpasa Training Hospital, Cardiovascular Surgery, Cardiovascular Surgery Clinic, Istanbul, Turkey; †GATA Haydarpasa Training Hospital Anesthesiology, Istanbul, Turkey
| | - Huseyin Sen
- GATA Haydarpasa Training Hospital, Cardiovascular Surgery, Cardiovascular Surgery Clinic, Istanbul, Turkey; †GATA Haydarpasa Training Hospital Anesthesiology, Istanbul, Turkey
| | - Ahmet Turan Yilmaz
- GATA Haydarpasa Training Hospital, Cardiovascular Surgery, Cardiovascular Surgery Clinic, Istanbul, Turkey; †GATA Haydarpasa Training Hospital Anesthesiology, Istanbul, Turkey
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Transcatheter closure of multi-hole perimembranous VSD with aneurysm: 3-year follow-up study. Clin Res Cardiol 2009; 98:563-9. [DOI: 10.1007/s00392-009-0044-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2009] [Accepted: 06/19/2009] [Indexed: 10/20/2022]
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Gadhinglajkar S, Sreedhar R, Gopalakrishnan SK, Sadiq A, Rao M, Gopal K. A left ventricular-to-right atrial shunt in a patient with a perimembranous ventricular septal defect: role of intraoperative transesophageal echocardiography. J Cardiothorac Vasc Anesth 2009; 23:675-8. [PMID: 19217800 DOI: 10.1053/j.jvca.2008.12.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2008] [Indexed: 11/11/2022]
Affiliation(s)
- Shrinivas Gadhinglajkar
- Department of Anesthesia, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Kerala, India.
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Legendre A, Bergoend E, Vaillant MC, Chantepie A. Unusual hemodynamic changes in an infant with a restrictive ventricular septal defect. Pediatr Cardiol 2008; 29:166-8. [PMID: 17874156 DOI: 10.1007/s00246-007-9075-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2006] [Revised: 05/09/2007] [Accepted: 07/03/2007] [Indexed: 10/22/2022]
Abstract
A 7-month-old asymptomatic infant was known to have a restrictive membranous ventricular septal defect partially closed by an aneurysm of the membranous septum. At 13 months of age, he developed unexpected pulmonary hypertension, with no clinical sign of cardiac failure. Cardiac catheterization assessed the pulmonary artery pressure at a systemic level with significant left-to-right shunt. After surgical closure, the pulmonary arterial pressure decreased by 50%. We suspect an enlargement of the ventricular septal defect caused by the rupture of the aneurysm of the membranous septum-a rare complication.
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Quintavalla C, Mavropoulou A, Buratti E. Aortic endocarditis associated with a perforated septal membranous aneurysm in a boxer dog. J Small Anim Pract 2007; 48:330-4. [PMID: 17425700 DOI: 10.1111/j.1748-5827.2006.00240.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Perimembranous ventricular septal defect is a common congenital heart disease in the dog. It can partially or completely close with age by development of a membranous ventricular septal aneurysm. Aortic endocarditis is a reported complication of ventricular septal defect and membranous ventricular septal aneurysm in human beings. This report describes a case of aortic endocarditis associated with a membranous ventricular septal aneurysm perforated by a small ventricular septal defect in a boxer dog.
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Affiliation(s)
- C Quintavalla
- Department of Animal Health, University of Parma, Via del Taglio 8, 43100 Parma, Italy
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Loukas M, Tubbs RS, Louis RG, Curry B. Pseudoaneurysm of the membranous septum, case report and review of the literature. Surg Radiol Anat 2006; 28:564-8. [PMID: 16906358 DOI: 10.1007/s00276-006-0136-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2006] [Accepted: 06/08/2006] [Indexed: 10/24/2022]
Abstract
Pseudoaneurysm (dissecting aneurysm) of the membranous septum is a rare occasion. Clinically, aneurysms and pseudoaneurysms not only have the potential to reduce ventricular size, but also can be further complicated by rupture of the aneurysm and by promoting tricuspid insufficiency, aortic valve prolapse, ventricular outflow tract obstruction, and bacterial endocarditis. We describe a case in which a pseudoaneurysm of the membranous septum was identified protruding into the left outflow tract.
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Affiliation(s)
- Marios Loukas
- Department of Anatomical Sciences, St. George's University, Grenada, West Indies.
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Espinoza J, Kalache K, Gonçalves LF, Lee W, Chaiworapongsa T, Schoen ML, Devers P, Treadwell M, Mazor M, Romero R. Prenatal diagnosis of membranous ventricular septal aneurysms and their association with absence of atrioventricular valve 'offsetting'. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2004; 24:787-792. [PMID: 15543526 DOI: 10.1002/uog.1769] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
Congenital aneurysm of the membranous portion of the ventricular septum in association with absence of atrioventricular valve 'offsetting' was diagnosed in two fetuses at 29 and 34 weeks. In the first case the fetus had a normal karyotype and no other structural heart defects, whereas in the second case there was a partial deletion of the long arm of chromosome 5 and an absent pulmonary valve syndrome. The association of absence of 'offsetting' with aneurysms of the membranous ventricular septum may represent spontaneous closure of ventricular septal defects initially extended to the inlet.
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Affiliation(s)
- J Espinoza
- Perinatology Research Branch, NICHD, NIH, DHHS, Detroit, MI 48201, USA
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Baweja G, Nanda NC, Nekkanti R, Dod H, Ravi B, Fadel A. Three-Dimensional Transesophageal Echocardiographic Delineation of Ventricular Septal Aneurysm Producing Right Ventricular Outflow Obstruction in an Adult. Echocardiography 2004; 21:95-7. [PMID: 14717733 DOI: 10.1111/j.0742-2822.2004.02163.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
We report three-dimensional echocardiographic delineation of a congenital aneurysm of the membranous interventricular septum causing right ventricular outflow tract obstruction in an adult patient. To our knowledge, these findings have not been described before.
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Affiliation(s)
- Gurpreet Baweja
- Division of Cardiovascular Disease, University of Alabama at Birmingham, Birmingham, AL 35233, USA
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Abstract
A 41-year-old man with a small perimembranous ventricular septal defect (VSD) developed aneurysms and aortic elongation, tortuosity and dissecting aneurysm. The asymptomatic VSD, without pulmonary circulatory disturbance, was considered hemodynamically benign and too small to warrant surgical closure. However, prolonged strenuous sporting activities could have potentiated premature development of aortic sclerosis and the unusual vascular lesions secondary to the VSD, and an injury may have precipitated mural dissection in the vulnerable aortic wall. Clinicopathological analysis of the unusual complications associated with the VSD suggests that closure of the defect at an early age should be considered to possibly obviate premature degenerative, valvular and vascular changes in adulthood and also secondary endocardial infection.
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Affiliation(s)
- W E Stehbens
- Department of Pathology and Molecular Medicine, Wellington School of Medicine, PO Box 7343, Wellington South, New Zealand.
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