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Successful management of multiple infected sub-mitral aneurysms of left ventricle.

Nair VV, Kalra R, Narang R, Airan B - Ann Pediatr Cardiol (2014)

Bottom Line: Sub-mitral aneurysms are rarely reported clinical entity.Though a variety of etiologies are proposed, congenital weakness of the mitral valve annulus is the most widely accepted one.The aneurysm wall was positive for Staphylococcus aureus, and patient was treated with intensive antibiotics.

View Article: PubMed Central - PubMed

Affiliation: Department of CTVS, Cardio-thoracic center, All India Institute of Medical Sciences, New Delhi, India.

ABSTRACT
Sub-mitral aneurysms are rarely reported clinical entity. Though a variety of etiologies are proposed, congenital weakness of the mitral valve annulus is the most widely accepted one. A 17-year-old boy with sub-mitral aneurysm presented with severe mitral regurgitation, which was diagnosed by echocardiography and successfully managed surgically. The aneurysm wall was positive for Staphylococcus aureus, and patient was treated with intensive antibiotics.

No MeSH data available.


Related in: MedlinePlus

Intra-operative view of the aneurysms. AN1/AN2 = aneurysms 1 and 2; LA = left atrium; PV = pulmonary vein
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Figure 3: Intra-operative view of the aneurysms. AN1/AN2 = aneurysms 1 and 2; LA = left atrium; PV = pulmonary vein

Mentions: Per-operative trans-esophageal echocardiography showed a sub-mitral aneurysm related to the posterior mitral annulus [Figure 1] causing eccentric mitral regurgitation [Figure 2]. Aortic valve leaflets were normal with mild regurgitation. Median sternotomy exposed an enlarged heart. The procedure was carried out under mild hypothermic cardiopulmonary bypass with cold blood cardioplegic arrest. The left atrium was opened, and mitral valve leaflets were found to be pliable. A sub-mitral aneurysm was identified in relation to the p2/p3 segments of the posterior annulus. Further delineation of the anatomy revealed a second aneurysm close to the posterior annulus at the p1/p2 junction [Figure 3]. First aneurysm sac was 4 × 4 cm with a narrow neck, while the second had a wider neck with a smaller sac. Left atrial appendage was clear; saline test demonstrated severe eccentric mitral regurgitation. The first aneurysmal sac was repaired with pledgeted interrupted monofilament polypropylene sutures passing through the left ventricular side of the aneurysm, the posterior mitral annulus, and the neck thereby obliterating it, and the excess sac was excised. The second aneurysm's neck was plicated with pledgeted polypropylene sutures passing through the neck and the annulus. Additional sutures were passed through the mitral annulus and the sac thereby plicating it, simultaneously strengthening that portion of the mitral annulus [Figure 4]. Saline test showed mild eccentric regurgitation jet through the posteromedial commissure. Posterior mitral annuloplasty was performed with a hard polytetrafluoroethylene (PTFE) felt providing a fully competent valve [Figure 5].


Successful management of multiple infected sub-mitral aneurysms of left ventricle.

Nair VV, Kalra R, Narang R, Airan B - Ann Pediatr Cardiol (2014)

Intra-operative view of the aneurysms. AN1/AN2 = aneurysms 1 and 2; LA = left atrium; PV = pulmonary vein
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3959061&req=5

Figure 3: Intra-operative view of the aneurysms. AN1/AN2 = aneurysms 1 and 2; LA = left atrium; PV = pulmonary vein
Mentions: Per-operative trans-esophageal echocardiography showed a sub-mitral aneurysm related to the posterior mitral annulus [Figure 1] causing eccentric mitral regurgitation [Figure 2]. Aortic valve leaflets were normal with mild regurgitation. Median sternotomy exposed an enlarged heart. The procedure was carried out under mild hypothermic cardiopulmonary bypass with cold blood cardioplegic arrest. The left atrium was opened, and mitral valve leaflets were found to be pliable. A sub-mitral aneurysm was identified in relation to the p2/p3 segments of the posterior annulus. Further delineation of the anatomy revealed a second aneurysm close to the posterior annulus at the p1/p2 junction [Figure 3]. First aneurysm sac was 4 × 4 cm with a narrow neck, while the second had a wider neck with a smaller sac. Left atrial appendage was clear; saline test demonstrated severe eccentric mitral regurgitation. The first aneurysmal sac was repaired with pledgeted interrupted monofilament polypropylene sutures passing through the left ventricular side of the aneurysm, the posterior mitral annulus, and the neck thereby obliterating it, and the excess sac was excised. The second aneurysm's neck was plicated with pledgeted polypropylene sutures passing through the neck and the annulus. Additional sutures were passed through the mitral annulus and the sac thereby plicating it, simultaneously strengthening that portion of the mitral annulus [Figure 4]. Saline test showed mild eccentric regurgitation jet through the posteromedial commissure. Posterior mitral annuloplasty was performed with a hard polytetrafluoroethylene (PTFE) felt providing a fully competent valve [Figure 5].

Bottom Line: Sub-mitral aneurysms are rarely reported clinical entity.Though a variety of etiologies are proposed, congenital weakness of the mitral valve annulus is the most widely accepted one.The aneurysm wall was positive for Staphylococcus aureus, and patient was treated with intensive antibiotics.

View Article: PubMed Central - PubMed

Affiliation: Department of CTVS, Cardio-thoracic center, All India Institute of Medical Sciences, New Delhi, India.

ABSTRACT
Sub-mitral aneurysms are rarely reported clinical entity. Though a variety of etiologies are proposed, congenital weakness of the mitral valve annulus is the most widely accepted one. A 17-year-old boy with sub-mitral aneurysm presented with severe mitral regurgitation, which was diagnosed by echocardiography and successfully managed surgically. The aneurysm wall was positive for Staphylococcus aureus, and patient was treated with intensive antibiotics.

No MeSH data available.


Related in: MedlinePlus