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Rare case of ruptured muscular ventricular septal aneurysm due to silent myocardial ischemia in adult



Case Reports

. 2022 May 24;2022(5):rjac114.


doi: 10.1093/jscr/rjac114.


eCollection 2022 May.

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Case Reports

Toshihiro Kawahira et al.


J Surg Case Rep.


.

Abstract

Interventricular septal aneurysm of muscular type is uncommon in adult, to say nothing of membranous type. Acute or subacute left-to-right shunt (LR shunt) in a ventricular septum is mostly critical and usually shows severe symptoms. Therefore, ruptured muscular ventricular septal aneurysm (VSA) with LR shunt of unknown onset in adult is highly rare. A 70-year-old man was suffered from mild dyspnea and chest oppression. A muscular VSA was detected at the center of the ventricular septum and LR shunt of unknown onset in it had induced congestive heart failure. The sandwich patch technique through a right ventricular approach was simultaneously performed with coronary artery bypass grafting and the postoperative course was uneventful. In addition, concomitant myocardial biopsy of VSA wall during the surgery could reveal histopathologic evidence of acute or subacute myocardial infarction with old myocardial infarction as silent myocardial ischemia.

Figures



Figure 1

ECG indicated normal sinus rhythm without abnormal Q wave.


Figure 2


Figure 2

VSA with LR shunt flow. RV: right ventricle, LV: left ventricle, VSA: ventricular septal aneurysm.


Figure 3


Figure 3

VSA at the center of ventricular septum (blue dot circle) with VSP to the RV cavity (white arrow) in the operative finding. VSA: ventricular septal aneurysm, VSP: ventricular septal perforation, RV: right ventricle.


Figure 4


Figure 4

Histopathologic image of VSA wall showed old myocardial ischemic lesion with fibrosis and flesh myocardial infarction area (Hematoxylin and Eosin stain: ×200).

References

    1. Naceur Y, Houissa K, Banaser A, Gharbaoui M, Bekir O, Daly Y, et al. Interventricular septal aneurysm: an exceptional cause of sudden death in young adult. J Forensic Sci Crimin Invest 2018;8:555731.

    1. Simon RD, Malcolm EL, Selwyn PW. Ventricular septal aneurysm: a complication of myocardial infarction. Echocardiography 2000;17:429–42.



      PubMed

    1. Derya A, Avni MK, Mahmut G. Aneurysm of cardiac muscular interventricular septum as a result of blunt chest trauma. Br J Hosp Med 2020;81:1–3.

    1. Hong LN, Nicolas P, Nasser L, Rashed T. Rare silent ischemic ventricular septal aneurysm and rupture: a multimodality diagnostic approach. Clin Case Rep 2021;9: e04284.

    1. Andrea F, Alberto A, Alessandra L, Antonio M, Francesco G, Antonio C. Post-ischemic ventricular septal pseudoaneurysm contained inside right ventricular cavity. Circ Cardiovasc Imaging 2020;13:e010561.



      PubMed



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