Subpulmonary Obstruction from Aneurysmal Ventricular Septum in a Child with Dextrocardia and Congenitally Corrected Transposition of the Great Arteries

An interventricular membranous septal aneurysm obstructing the right ventricle outflow tract in a five-year-old boy: a case report

Background

While the aneurysms of the membranous septum (AVS) are rare, the possibility that they lead to obstruction is even rarer. To the best of our knowledge, 11 similar cases have been reported since 1982.

Case presentation

Initially, the five-year-old boy was evaluated for dyspnoea that had been present since birth. He did not receive any medical treatment until the previous year. At the age of four, the transthoracic echocardiography showed a large aneurysm extending to the right ventricular outflow tract (RVOT) and causing RVOT stenosis. Complete surgical resection of the aneurysmal tissue was performed, and the boy was discharged home in satisfactory condition.

Conclusions

As the occurrence of RVOT obstruction by a membranous ventricular septal aneurysm is very rare, we are reporting the second case in which an aneurysm of the membranous septum dynamically obstructed the RVOT in a child. We are also reviewing all the previously reported similar cases in the literature. Further studies are needed to obtain a more comprehensive understanding of aneurysms of the membranous septum (AVS).

The Author's Contributions to Echocardiography Literature (Part II-1991-2020)

The author's contribution up to 1990 was reviewed in part I and the echo contributions from 1991 to 2020 will be reviewed in part II. These include defining the relationship between the quantity of shunt across the atrial septal defect (ASD) and the diameter of ASD by echo and angio on the one side and the stretched diameter of the ASD on the other; echocardiographic assessment of balloon-stretched diameter of secundum ASDs; development of echocardiographic predictors of accomplishment of percutaneous closure of ASDs with the buttoned device, highlighting limitations of echocardiography in comprehensive assessment of mixed type of total anomalous pulmonary venous connection; description of follow-up echocardiographic results of transcatheter closure of ASD with buttoned device; review of ultrasound studies; depiction of collaborative echocardiographic and Doppler studies; echocardiographic appraisal of the outcome of balloon pulmonary valvuloplasty; editorials; ventricular septal aneurysm causing pulmonary outflow tract obstruction in the morphologic left ventricle in corrected transposition of the great arteries; dependability of echocardiographic assessment of angiographic minimal diameter of the ductus; occurrence of supravalvular pulmonary artery stenosis after a Nuss procedure; echocardiographic assessment of neonates who were suspected of having heart disease; role of echocardiographic studies in the appraisal of patent ductus arteriosus in the premature babies; and the role of pressure recovery in explaining differences between simultaneously measured Doppler and cardiac catheterization pressure gradients across outflow tract stenotic lesions.