MR and CT findings in infected ventricular aneurysm repair

Staphylococcus Aureus Pancarditis Complicated by a Left Ventricular Pseudoaneurysm

Acute septic pancarditis is a life threatening but fortunately rare condition. We report a case of this condition in a young 20-year-old female patient with an early complication of mitral valve destruction and a late complication of a left ventricular pseudoaneurysm formation.

Infectious pseudoaneurysms suspected at echocardiography: electron-beam CT findings

PURPOSE

To review the electron-beam computed tomographic (CT) findings in patients with clinical endocarditis and suspected of having perivalvular pseudoaneurysms at echocardiography and to compare these findings with echocardiographic data.

MATERIALS AND METHODS

Data on 17 patients who underwent electron-beam CT for suspicion of perivalvular infectious pseudoaneurysm at echocardiography were retrospectively reviewed. Thirteen patients had a history of valvular surgery. Electron-beam CT findings-lesion size, number, extent, and relationships with surrounding structures, and associated lesions-were compared with echocardiographic and surgical and/or autopsy data.

RESULTS

In all patients, electron-beam CT depicted one or more abnormal cavities that filled with contrast material after bolus injection. The mean size (3.5 cm) and number (n = 21) of pseudoaneurysms recorded with electron-beam CT were greater than those recorded with echocardiography (2.9 cm and n = 13, respectively). Associated electron-beam CT findings included valvular vegetations in three patients; mediastinitis in two; and coronary arterial involvement in six. In eight (47%) patients, electron-beam CT depicted a pseudoaneurysm or an additional pseudoaneurysm that was only suspected-not depicted-at echocardiography. Transthoracic and transesophageal echocardiography resulted in underestimation of lesion number, size, and extent and associated lesions, particularly in patients with valvular prostheses or voluminous lesions.

CONCLUSION

Thoracic infectious pseudoaneurysms are well depicted with electron-beam CT, which may be a useful addition to echocardiography for detection of this disease and thus help in preoperative planning.

Pericardial patch repair of left ventricular aneurysm

Infectious complications associated with the use of Teflon felt buttresses in left ventricular aneurysm repair may result in serious morbidity. Use of an autologous pericardial patch is an alternative approach that should be considered. The technique, which we have used in 4 patients, is described.