Annular subvalvular left ventricular aneurysm in Bahia, Brazil

Idiopathic subvalvular aortic aneurysm masquerading as acute coronary syndrome

Subvalvular aneurysms are the least common type of left ventricular (LV) aneurysms and can be fatal. Subaortic LV aneurysms are much rarer than submitral LV aneurysms and mostly reported in infancy. They can be congenital or acquired secondary to infections, cardiac surgery or trauma. Here, we report a unique presentation of a large, idiopathic subaortic aneurysm in an adult masquerading as an acute coronary syndrome. Diagnosis was made with the help of a CT aortography. Aneurysm was surgically resected with good results. This case highlights the clinical presentation and management of subaortic aneurysms, an important differential for congenital aortic malformations.

Characteristics and outcome of congenital left ventricular aneurysm and diverticulum: Analysis of 809 cases published since 1816

BACKGROUND

Congenital left ventricular aneurysm (LVA) or diverticulum (LVD) is rare cardiac anomalies. We aimed to analyse the clinical characteristics and outcome in all ever published patients.

METHODS

MEDLINE, Web of science, Google and EMBASE, and reference lists of relevant articles were searched for publications reporting on LVA or LVD patients.

RESULTS

We identified 809 patients published since 1816 [354 (49.1%) LVA, 453 (50.6%) LVD, 2 (0.3%) both]. Mean age at diagnosis was 34.1±27 (LVA) and 29.7±27.6years (LVD; p=0.05). 48.9% were male. LVA was larger (38.7±22.5mm versus 31.4±21.2mm; p=0.002) and frequently found in submitral location (33% versus 4.9%; p<0.001), LVD was frequently located at the LV-apex (61.2% versus 28.7%; p<0.001). LVD was often associated with cardiac (34.2% versus 11%; p<0.001) or extracardiac anomalies (32.7% versus 3%; p<0.001). LVA patients presented more frequently with ventricular tachycardia/fibrillation (18.1% versus 13.1%; p=0.01), the incidences of rupture (4% versus 4.5%; p=0.9), syncope (8.3% versus 5.1%; p=0.1), and embolic events (4.9% versus 3.6%; p=0.4) at presentation were not different between LVA and LVD. Mean follow-up was 56.3±43months. Cardiac death occurred more frequently in the LVA group (11.5% versus 5.0%; p=0.05) at a median age of 0.8 [LVA] and 2.5 [LVD] years. The leading cause of cardiac death was congestive heart failure in the LVA-group (50.0% versus 0.0%; p=0.01), and rupture in the LVD-group (75.0% versus 27.3%; p=0.04).

CONCLUSIONS

LVA and LVD are distinct congenital anomalies with different clinical and morphological characteristics. The prognosis of LVA is significantly worse during long-term follow-up.

Ruptured submitral aneurysm in an eight-year-old girl

We present illustrative images of submitral aneurysm in a young girl. The diagnosis was established on echocardiography and the extent of the problem was defined through multi-detector computerized tomography.

Perforated submitral left ventricular aneurysm resulting in severe mitral annular regurgitation

Annular submitral left ventricular aneurysm, which predominantly occurs in blacks who live in tropical regions of Africa, is a relatively unknown cardiac condition in the United States. We describe a patient with submitral left ventricular aneurysm who underwent resection of the mass and of the native mitral valve, followed by mitral valve replacement.

Repair of posterior left ventricular aneurysm in a six-year-old boy

Left ventricular aneurysms and diverticula are rarely encountered in the pediatric age group. This paper reports a case of congestive heart failure and mitral regurgitation in a 6-year-old boy with a large posterolateral left ventricular aneurysm. Complete repair was successfully performed by excision of the aneurysm and Dacron patch reconstruction of the left ventricular free wall. The patch extended onto the posterior annulus of the mitral valve, thus restoring the mitral valve to normal geometry and correcting the mitral insufficiency. The surgical literature on congenital cardiac diverticula and acquired aneurysms in children is reviewed and summarized.

Annular subaortic aneurysm resulting in sudden death

A subvalvular aneurysm in a 34-year-old black woman developed beneath the left coronary cusp of the aortic valve and extended in the epicardium between the aortic root and left atrium. She was asymptomatic until she expired suddenly from myocardial ischemia caused by compression of the circumflex coronary artery by the aneurysm. A review of the literature reveals 13 reports of subaortic and 58 submitral aneurysms but only two instances of myocardial infarction secondary to coronary artery compression by spontaneous subvalvular aneurysms in either the subaortic or submitral position.

Cross-sectional echocardiographic recognition of submitral left ventricular aneurysm

Three cases of annular submitral left ventricular aneurysm precisely diagnosed by cross-sectional echocardiography are reported from the Indian subcontinent. The cineangiographic findings are available in all and morphologic findings in two cases. The apical four-chamber view demonstrated a characteristically large aneurysm arising below the mural leaflet of the mitral valve extending anterolaterally and posteriorly and communicating with the left ventricular cavity in all the cases. Contrast echocardiography performed during cardiac catheterisation promises to be a good technique for the qualitative assessment of the associated mitral regurgitation. Cross-sectional echocardiography is invaluable in diagnosis and assessment of results of surgery in this entity.

Subvalvar aneurysms of the left ventricle

Five cases of subvalvar aneurysm of the left ventricle are reported. The location of the aneurysm was sub-mitral in three and sub-aortic in two. The clinical, echocardiographic, angiocardiographic and pathological features are described.

Congenital diverticulum of the left ventricle. Report of two unusual cases

Of two infants with congenital cardiac diverticula one had a defect consisting of a submitral valvular diverticulum rather than the expected aneurysm. It was clearly shown by echocardiography as well as angiography and was associated with moderate mitral incompetence and a poorly functioning left ventricular wall. The second infant had an isolated apical left ventricular diverticulum with subnormal left ventricular function and severe mitral incompetence. Because of intractable congestive heart failure this infant underwent successful replacement of a dysplastic fibrotic mitral valve which on histological examination had myxomatous features. The association between congenital mitral disease and congenital apical diverticular may be related to race and sex.

Left ventricular aneurysm in a child

A child with a large ventricular aneurysm was completely free of symptoms when admitted to the hospital; a chest-x-ray previously performed because of acute pneumonia had evidenced a bulge of the left border of the heart. The diagnosis of left ventricular aneurysm was verified by left ventricular angiography. Selective coronary angiography and angiocardiography of the right heart were also performed.

Calcified left ventricular aneurysm in a 6-year-old Caucasian boy

A 6-year-old Caucasian boy presented with a calcified left ventricular aneurysm of unknown aetiology. Aneurysmectomy was carried out uneventfully. A review of the English language papers reveals that this is the first reported case of a calcified left ventricular aneurysm occurring in a Caucasian child.

Annular subvalvular left ventricular aneurysm mimicking a pericardial effusion on echocardiogram

Annular subvalvular left ventricular aneurysms are a rare form of herniation of the left ventricle, reported usually in negroes. These aneurysms are situated beneath the mitral or aortic valves and extend along the line of the valvular annulus. The aetiology remains speculative but is not associated with coronary artery disease. Our patient was Caucasian and a review of the literature reveals only four other documented cases in Caucasians. Our case corresponds completely in pathological detail with previous cases. This condition has never been reported in Australia. The echocardiographic features have not been described before. These are the presence of a large echo free space behind the left ventricle, without an interior free space. These features are not specific but this type of aneurysm should be considered in the differential diagnosis of a loculated posterior pericardial effusion, along with a large left atrium and a hernia through a patent foramen of Morgagni.