ABSTRACT
Unruptured aneurysm of sinus of Valsalva (SOV) is extremely rare. They may be asymptomatic and diagnosed incidentally or can present with either fatal outcome following rupture or manifest acutely with compression of surrounding structures. Dissection of unruptured aneurysm of left SOV into interventricular septum (IVS) and presenting as intramyocardial mass is not reported in the literature. We are reporting a case of 21-year-old man who was referred to us following a seizure episode and was incidentally diagnosed with aneurysm of left SOV dissecting into IVS. Multimodality imaging confirmed the diagnosis. He successfully underwent surgical repair and was asymptomatic during follow-up.
Subject(s)
Aortic Aneurysm/diagnosis , Aortic Aneurysm/surgery , Aortic Dissection/diagnosis , Aortic Dissection/surgery , Sinus of Valsalva/surgery , Adult , Aorta/diagnostic imaging , Aorta/pathology , Aortography/methods , Cardiomyopathies , Cysts , Diagnosis, Differential , Follow-Up Studies , Humans , Magnetic Resonance Imaging/methods , Male , Tomography, X-Ray Computed/methods , Treatment Outcome , Ultrasonography , Ventricular Septum/diagnostic imaging , Ventricular Septum/pathology , Young AdultABSTRACT
A 40-year-old woman, known to suffer from rheumatic heart disease, presented with New York Heart Association class III breathlessness of 6 months duration. Transthoracic echocardiogram revealed severe mitral stenosis with deformed double orifice-like mitral valve and severe interatrial septal bulge. Considering the unfavourable anatomy, a high-risk percutaneous transluminal mitral commissurotomy (PTMC) was planned. Initial septal puncture resulted in pericardial effusion with tamponade, which was effectively managed by pericardiocentesis. After haemodynamic stabilisation and a fresh septal puncture, repeated efforts were made to negotiate the balloon across the deformed valve using the conventional Inoue technique. As the attempts were unsuccessful, the authors planned for over-the-wire (OTW) technique, with which the procedure was accomplished successfully. A technically challenging case of PTMC in the presence of adverse factors is presented herein. OTW technique is a useful alternative in the presence of deformed mitral valve.
Subject(s)
Mitral Valve Stenosis/surgery , Mitral Valve/abnormalities , Mitral Valve/surgery , Adult , Cardiac Surgical Procedures/methods , Female , HumansABSTRACT
Percutaneous transluminal septal myocardial ablation is an established therapeutic option for symptomatic hypertrophic obstructive cardiomyopathy refractory to medical therapy. It is a safe procedure in experienced hands, but complications can occur. We report two cases of right ventricular myocardial infarction with inferior wall infarction that occurred after alcohol ablation of the septum. There are no standard guidelines regarding the most appropriate treatment strategy in this clinical scenario. The probable mechanism and management issues are discussed.
