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A case of left ventricular pseudoaneurysm in the left atrioventricular groove after mitral valve replacement.

Jung HS, Chung WB, Yang KS, Yang HK, Gweon TG, Lee GJ, Hong JH, Jung JI, Song H, Youn HJ - J Cardiovasc Ultrasound (2010)

Bottom Line: A 27-year-old female patient underwent mitral valve replacement 5 years previously and trans-thoracic echocardiography showed an outpouching lesion at the atrioventricular groove.It was difficult to differentiate whether the lesion was a left ventricle-coronary sinus fistula or a left ventricular pseudoaneurysm by two-dimensional echocardiography.Cardiac computed tomography confirmed a left ventricular pseudoaneurysm compressing the coronary sinus.

View Article: PubMed Central - PubMed

Affiliation: Division of Cardiology, Department of Internal Medicine, School of Medicine, The Catholic University of Korea, Seoul, Korea.

ABSTRACT
Left ventricle-coronary sinus fistula and left ventricular pseudoaneurysm are unusual and frightening complications after mitral valve replacement. A 27-year-old female patient underwent mitral valve replacement 5 years previously and trans-thoracic echocardiography showed an outpouching lesion at the atrioventricular groove. It was difficult to differentiate whether the lesion was a left ventricle-coronary sinus fistula or a left ventricular pseudoaneurysm by two-dimensional echocardiography. Cardiac computed tomography confirmed a left ventricular pseudoaneurysm compressing the coronary sinus.

No MeSH data available.


Related in: MedlinePlus

The coronal plane (A) and short axis plane (B) of cardiac CT show the outpouching pseudoaneurysm arising from the postero-inferior wall of the left ventricle, just beneath the replaced prosthetic mitral valve. Cardiac CT shows the aneurysmal sac at the AV-groove without a discernible wall, and this was considered to be a pseudoaneurysm. The pseudoaneurysm compressed the opening of the coronary sinus, resulting in dilatation of the coronary sinus (arrow)(C). The three-dimensional reconstruction image of cardiac CT shows the pseudoaneurysm and dilated coronary sinus (arrow)(D).
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Figure 2: The coronal plane (A) and short axis plane (B) of cardiac CT show the outpouching pseudoaneurysm arising from the postero-inferior wall of the left ventricle, just beneath the replaced prosthetic mitral valve. Cardiac CT shows the aneurysmal sac at the AV-groove without a discernible wall, and this was considered to be a pseudoaneurysm. The pseudoaneurysm compressed the opening of the coronary sinus, resulting in dilatation of the coronary sinus (arrow)(C). The three-dimensional reconstruction image of cardiac CT shows the pseudoaneurysm and dilated coronary sinus (arrow)(D).

Mentions: The TTE showed good LV systolic function (ejection fraction: 65%) without regional wall motion abnormality. The prosthetic mitral valve function was good without any paravalvular leakage. Mild resting pulmonary hypertension (43 mmHg) was observed, but the right ventricle was not dilated. There was a 25×23 mm sized outpouching lesion with a neck distance of 6 mm on the postero-interior wall of the LV below the mitral annulus. TTE also revealed draining flow and redundant motion (Fig. 1). However, it is difficult to distinguish between a left ventricle-coronary sinus fistula and a LV pseudoaneurysm as the opening site of the lesion was the postero-inferior wall where the coronary sinus drains. But the echocardiographic findings suggested that it was more likely a LV pseudoaneurysm because if it was a left ventricle-coronary sinus fistula, then volume overload to the right side of the heart may result in dilation of the right atrium and right ventricle. CCT was then done. It showed about a 30×25 mm sized outpouching lesion arising from a defect of the posteroinferior wall of the LV, just beneath the replaced mitral valve (Fig. 2A and B). The aneurysmal sac was observed at the AV-groove without a discernible wall, and it was considered to be a pseudoaneurysm (Fig. 2C). The pseudoaneurysm was compressing the opening of the coronary sinus, resulting in dilatation of the coronary sinus and the adjacent cardiac veins. The pseudoaneurysm and dilated coronary sinus were clearly demonstrated on the three-dimensional reconstruction image (Fig. 2D). According to the CCT findings, we were able to confirm a LV pseudoaneurysm. We recommended surgical intervention, but the patient refused to undergo any further evaluation and treatment. The patient is regularly visiting the outpatient department with no definite symptoms.


A case of left ventricular pseudoaneurysm in the left atrioventricular groove after mitral valve replacement.

Jung HS, Chung WB, Yang KS, Yang HK, Gweon TG, Lee GJ, Hong JH, Jung JI, Song H, Youn HJ - J Cardiovasc Ultrasound (2010)

The coronal plane (A) and short axis plane (B) of cardiac CT show the outpouching pseudoaneurysm arising from the postero-inferior wall of the left ventricle, just beneath the replaced prosthetic mitral valve. Cardiac CT shows the aneurysmal sac at the AV-groove without a discernible wall, and this was considered to be a pseudoaneurysm. The pseudoaneurysm compressed the opening of the coronary sinus, resulting in dilatation of the coronary sinus (arrow)(C). The three-dimensional reconstruction image of cardiac CT shows the pseudoaneurysm and dilated coronary sinus (arrow)(D).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3021897&req=5

Figure 2: The coronal plane (A) and short axis plane (B) of cardiac CT show the outpouching pseudoaneurysm arising from the postero-inferior wall of the left ventricle, just beneath the replaced prosthetic mitral valve. Cardiac CT shows the aneurysmal sac at the AV-groove without a discernible wall, and this was considered to be a pseudoaneurysm. The pseudoaneurysm compressed the opening of the coronary sinus, resulting in dilatation of the coronary sinus (arrow)(C). The three-dimensional reconstruction image of cardiac CT shows the pseudoaneurysm and dilated coronary sinus (arrow)(D).
Mentions: The TTE showed good LV systolic function (ejection fraction: 65%) without regional wall motion abnormality. The prosthetic mitral valve function was good without any paravalvular leakage. Mild resting pulmonary hypertension (43 mmHg) was observed, but the right ventricle was not dilated. There was a 25×23 mm sized outpouching lesion with a neck distance of 6 mm on the postero-interior wall of the LV below the mitral annulus. TTE also revealed draining flow and redundant motion (Fig. 1). However, it is difficult to distinguish between a left ventricle-coronary sinus fistula and a LV pseudoaneurysm as the opening site of the lesion was the postero-inferior wall where the coronary sinus drains. But the echocardiographic findings suggested that it was more likely a LV pseudoaneurysm because if it was a left ventricle-coronary sinus fistula, then volume overload to the right side of the heart may result in dilation of the right atrium and right ventricle. CCT was then done. It showed about a 30×25 mm sized outpouching lesion arising from a defect of the posteroinferior wall of the LV, just beneath the replaced mitral valve (Fig. 2A and B). The aneurysmal sac was observed at the AV-groove without a discernible wall, and it was considered to be a pseudoaneurysm (Fig. 2C). The pseudoaneurysm was compressing the opening of the coronary sinus, resulting in dilatation of the coronary sinus and the adjacent cardiac veins. The pseudoaneurysm and dilated coronary sinus were clearly demonstrated on the three-dimensional reconstruction image (Fig. 2D). According to the CCT findings, we were able to confirm a LV pseudoaneurysm. We recommended surgical intervention, but the patient refused to undergo any further evaluation and treatment. The patient is regularly visiting the outpatient department with no definite symptoms.

Bottom Line: A 27-year-old female patient underwent mitral valve replacement 5 years previously and trans-thoracic echocardiography showed an outpouching lesion at the atrioventricular groove.It was difficult to differentiate whether the lesion was a left ventricle-coronary sinus fistula or a left ventricular pseudoaneurysm by two-dimensional echocardiography.Cardiac computed tomography confirmed a left ventricular pseudoaneurysm compressing the coronary sinus.

View Article: PubMed Central - PubMed

Affiliation: Division of Cardiology, Department of Internal Medicine, School of Medicine, The Catholic University of Korea, Seoul, Korea.

ABSTRACT
Left ventricle-coronary sinus fistula and left ventricular pseudoaneurysm are unusual and frightening complications after mitral valve replacement. A 27-year-old female patient underwent mitral valve replacement 5 years previously and trans-thoracic echocardiography showed an outpouching lesion at the atrioventricular groove. It was difficult to differentiate whether the lesion was a left ventricle-coronary sinus fistula or a left ventricular pseudoaneurysm by two-dimensional echocardiography. Cardiac computed tomography confirmed a left ventricular pseudoaneurysm compressing the coronary sinus.

No MeSH data available.


Related in: MedlinePlus