Atrial Septal Aneurysm and Atrial Septal Defect Association - an Uncommon But Well-Recognized Association

Abstract Atrial septal aneurysm (ASA) is an uncommon but well-recognized cardiac abnormality. This educational text reviews the case of a 54-year-old female presenting an ASA related to a small ostium secundum atrial septal defect. The considerable signs and symptoms, interestingly, have not been justified by the clinical and hemodynamic investigations. So, we opted for a better imaging investigation with cardiac catheterization and transesophageal echocardiography. The surgical process was earlier indicated and performed with aid of cardiopulmonary bypass.

Aneurisma apical en paciente con miocardiopatía hipertrófica / Apical aneurysm in a patient with hypertrophic cardiomyopathy

We report a 51-year-old asymptomatic male, with type II diabetes, referred to our outpatient clinic due to ST and T alterations on the precordial leads on the electrocardiogram. The echocardiogram showed apical akinesia and left ventricular hypertrophy. There were no angiographic lesions in the coronary angiography. In the left ventriculography, a hyperdynamic left ventricle with suspected left ventricular hypertrophy and an apical aneurysm were found. The cardiac magnetic resonance confirmed those findings, without late gadolinium enhancement. According to the European Cardiology Society Risk Score, the patient had a low sudden death risk. However, this score does not consider the presence of an aneurysm as risk factor for sudden death, but it is considered in the 2017 ACC/AHA Heart Rhythm Society Guidelines, as a major risk factor. Therefore a defibrillator was implanted, and he was discharged on permanent oral anticoagulation.

Transaneurysmal R=repair of a giant calcified submitral left ventricular aneurysm

Abstract Submitral left ventricular aneurysm is a rare cardiac pathology with very few cases reported in the literature. These are nonischemic aneurysms mostly reported from Africa. Patients with submitral aneurysm exhibit varied clinical manifestations. We report a case of calcified submitral aneurysm and its successful surgical management through a transaneurysmal approach.

Congenital aneurysm of the right atrium: two cases report

Abstract Congenital aneurysm or enlargement of the right atrium is a rare condition. Two children operated on at the age of 14 months and 11 years old for congenital aneurysm of the right atrium are reported. Both presented cardiomegaly and symptoms of paroxysmal supraventricular tachycardia. Diagnosis was established by echocardiography. Surgical resection was successful. Both patients are free of symptoms and their chest X-ray and echocardiogram are normal. The first patient is now in her 17th postoperative year. The patients' evolution suggests that the surgery is a curative procedure.

Application of circular patch plasty (dor procedure) or linear repair techniques in the treatment of left ventricular aneurysms

Abstract Objective: The aim of this study was to evaluate early clinical outcomes and echocardiographic measurements of the left ventricle in patients who underwent left ventricular aneurysm repair using two different techniques associated to myocardial revascularization. Methods: Eighty-nine patients (74 males, 15 females; mean age 58±8.4 years; range: 41 to 80 years) underwent post-infarction left ventricular aneurysm repair and myocardial revascularization performed between 1996 and 2016. Ventricular reconstruction was performed using endoventricular circular patch plasty (Dor procedure) (n=48; group A) or linear repair technique (n=41; group B). Results: Multi-vessel disease in 55 (61.7%) and isolated left anterior descending (LAD) disease in 34 (38.2%) patients were identified. Five (5.6%) patients underwent aneurysmectomy alone, while the remaining 84 (94.3%) patients had aneurysmectomy with bypass. The mean number of grafts per patient was 2.1±1.2 with the Dor procedure and 2.9±1.3 with the linear repair technique. In-hospital mortality occurred in 4.1% and 7.3% in group A and group B, respectively (P>0.05). Conclusion: The results of our study demonstrate that post-infarction left ventricular aneurysm repair can be performed with both techniques with acceptable surgical risk and with satisfactory hemodynamic improvement.

Symmetrical peripheral gangrene complicating ventricular pseudoaneurysm: a report of an unusual case and a brief review of the literature

Abstract Symmetrical peripheral gangrene is an ischemic necrosis simultaneously involving the distal portions of two or more extremities without any proximal arterial obstruction or vasculitis. It may occur as a result of a large number of infectious and non-infectious causes. A few cases of symmetrical peripheral gangrene associated with cardiac disease have been described in the literature. We describe a case of symmetrical peripheral gangrene complicating ventricular pseudoaneurysm, probably a hitherto unreported occurrence. In this report, we sought to emphasize the importance of cardiac evaluation while dealing with a case of symmetrical peripheral gangrene.

Aneurismas y divertículos cardíacos congénitos: reporte de una serie pediátrica / Congenital cardiac aneurysms and diverticula: a pediatric series

Introduccion: Los aneurismas y divertículos cardíacos congénitos constituyen malformaciones poco frecuentes y generalmente comprometen el ventrículo izquierdo. Pueden presentarse en forma asintomática, causar embolización, arritmia, insuficiencia cardíaca, rotura o muerte súbita. La ecocardiografía Doppler color realiza el diagnóstico y detecta malformaciones asociadas. La terapia puede ser médica o quirúrgica dependiendo de la presentación clínica y de los hallazgos en cada paciente. Método: Estudio retrospectivo de 5 pacientes durante un período de diez años, uno con divertículo, cuatro con aneurismas, en los cuales se analizó sexo, edad, motivo de consulta, sintomatología, hallazgos al examen físico, malformaciones extracardíacas o cardíacas asociadas. La ecocardiografía confirmó el diagnóstico y analizó la localización, efecto sobre la función cardíaca y presencia de complicaciones. Se estudió el tipo de tratamiento elegido como terapia antiplaquetaria, antiarrítmica o quirúrgica, además del seguimiento. Resultados: De un total de 5 pacientes, tres eran hombres, la mediana de edad al diagnóstico fue de 13 meses; dos de diagnóstico antenatal. Soplo cardíaco (3/5) fue el principal hecho que motivó el estudio. La ubicación más frecuente fue en el ventrículo izquierdo y la malformación cardíaca asociada la comunicación interventricular (2 pacientes). La terapia elegida fue médica en todos los pacientes con aspirina y en un caso se agregó atenolol por taquicardia ventricular no sostenida. Ningún paciente falleció. Conclusion: Constituye la primera publicación sobre esta patología en nuestro país; si bien es una serie pequeña, aporta aspectos clínicos, diagnósticos y de seguimiento que ayudan a sospechar esta rara malformación en el paciente pediátrico.

Introduction: Congenital cardiac aneurysms and diverticula are rare cardiac malformations which mainly affects the left ventricle. Clinically, most are asymptomatic or may cause systemic embolization, arrhyth-mia, heart failure, ventricular wall rupture or sudden cardiac death. Doppler echocardiography establishes the diagnosis and can detect associated malformations. Treatment may be medical or surgical, depending on findings. Patients and Methods: Retrospective study of 5 patients followed for ten years. One patient presented with a diverticulum and four with aneurysms. We analyzed sex, age at diagnosis, symptoms, physical examination, and associated cardiac and extracardiac malformations. Echocardiography confirmed the diagnosis and established location, cardiac function, and presence of complications. We analyzed the treatments used: antiplatelet, anti-arrhythmic or surgical therapy, and follow up. Results: Three were males, the median age at diagnosis was 13 months; in two patients the diagnosis was made before birth. Heart murmur in 3 of 5 patients was the main presenting finding. The most frequent location was the left ventricle and the associated cardiac malformation was ventricular septal defect in 2 patients. All patients were treated with aspirin. One patient with non-sustained ventricular tachycardia received ateno-lol. There were no deaths. Conclusion: This is the first report of this disease in our country. Although it is a small series it provides important clinical aspects for the diagnosis, treatment and follow-up that help us suspect this rare malformation in pediatric patients.

Impressive echocardiographic images of a rare pathology: aneurysm of the mitral valve - report of two cases and review of the literature

Aneurysm of the mitral valve [AMV] is rarely reported. The etiology of this unusual pathology is commonly attributed to aortic valve endocarditis [AVE] with aortic regurgitation [AR] or connective tissue disease. We present two recent cases of AMV with good correlation between pre-operative trans-esophageal echocardiography [TEE], intra-operative real-time 3-dimensional echocardiography [RT-3D-Echo] and surgical findings. The importance of diligent surveillance by TEE in patients with AVE for occurrence of AMV is emphasized. The literature on this topic is briefly reviewed

Incidentally Found, Growing Congenital Aneurysm of the Left Atrium

A left atrial aneurysm is a very rare cardiac anomaly that usually develops in the left atrial appendage. It usually develops congenitally, and has a risk of life-threatening complications. Here, we report a case of a growing aneurysm of the left atrium that was incidentally found in a 42-yr-old woman. Eighteen years prior, an abnormal cardiomegaly was found on a chest radiography for a pre-operative study. The chest radiography at this time demonstrated a more prominent cardiomegaly than the previous radiography findings. The left atrial aneurysm was diagnosed by echocardiography and cardiac catheterization. Although asymptomatic, she underwent a successful surgical excision to allay the possibilities of rupture, arrhythmia, heart failure, or thromboembolism. The surgical findings demonstrated an 8 x 15 cm sized saccular aneurysm at the left atrial appendage, and the pathologic findings showed three myocardial layers. The patient has been asymptomatic during the 15 months of follow-up. In conclusion, a congenital left atrial aneurysm can grow with time, even in asymptomatic cases, and an aneurysmectomy is a curative treatment, which can eliminate the potential complications.

Left ventricular aneurysm: angiographic determinants.

To determine antiographic factors involved in left ventricular aneurysm formation after myocardial infarction, 50 patients with a first anterior wall myocardial infarction who underwent cardiac catheterisation within 6 months of infarction were evaluated. Extent of coronary artery disease and status of collateral circulation were studied in detail. Thirty patients had aneurysm in apical region while 20 patients showed aneurysm in anteroapical region. Coronary angiography revealed single-vessel disease in 17 patients, double-vessel disease in 17 patients and triple-vessel disease in 15 patients while in one patient coronary angiogram was normal. Fortynine patients showed significant involvement of left anterior descending artery which was poorly collateralised. Left anterior descending artery disease in association with inherent poor collateral blood supply may predispose for aneurysm formation after anterior wall myocardial infarction.