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European Heart Journal Advance Access originally published online on May 7, 2007
European Heart Journal 2007 28(19):2360; doi:10.1093/eurheartj/ehm120
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© The European Society of Cardiology 2007. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org

Left ventricular pseudoaneurysm as a late complication of mitral annuloplasty

Katerina Linhartová1,*, Josef Veselka1 and Theodor Adla2

1 Department of Cardiology, Cardiovascular Center, Charles University Hospital Motol, V Úvalu 84, 150 06 Prague, Czech Republic
2 Department of Imaging Methods, Charles University Hospital Motol, Prague, Czech Republic

* Corresponding author. Tel: +420 224434904. E-mail address: linhartkaterina{at}atlas.cz

A 59-year-old hypertensive male, 1 year after uncomplicated mitral annuloplasty for regurgitation with MAZE procedure, with a history of chronic obstructive pulmonary disease and repeated pulmonary embolism, returned to our intensive care unit for a transient episode of dyspnoea and chest pain, which quickly subsided on treatment.

Echocardiography revealed a bizarre pulsating sac in the usual transverse sinus localization between the left atrium, the ascending aorta, and the pulmonary artery (Panels A and B). We diagnosed a left ventricular (LV) pseudoaneurysm 50 mm in length, with a narrow orifice in the subaortic region of the LV outflow tract, adjacent to the mitral annuloplastic ring (Panel C). The dual-source computer tomography added information on the size and spatial orientation of the pseudoaneurysm (Panel D). The coronary angiogram was normal. The patient was referred to surgery, and a 3 mm entry of the pseudoaneurysm was successfully closed by a stitch.

This accidentally discovered LV pseudoaneurysm originating from the aorto-mitral junction was a rare late complication of mitral annuloplasty with an asymptomatic progressive course.

Panel A. Transoesophageal long axis, arrow at the pseudoaneurysm entry in the LV outflow tract.

Panel B. Short-axis view, pseudoaneurysm (PSA) adjacent to the left (l) and non-coronary (n) aortic valve cusps.

Panel C. Flow into the pseudoaneurysm at systole.

Panel D. Two-dimensional multiplanar reconstruction clearly depicts pseudoaneurysm (PSA) between the left atrium (LA), the ascending aorta (AA), and the pulmonary artery (PA).

See online supplementary material for movie clips of depicted echocardiographic images at European Heart Journal online.

This article was supported by the grant NR/8306-5 from the Internal Grant Agency, Ministry of Health, Prague, Czech Republic.

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This Article
Right arrow FREE Full Text (PDF) Freely available
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Right arrow All Versions of this Article:
28/19/2360    most recent
ehm120v1
Right arrow E-letters: Submit a response
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Right arrow Articles by Linhartová, K.
Right arrow Articles by Adla, T.
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Right arrow Articles by Linhartová, K.
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