European Heart Journal Advance Access originally published online on January 17, 2008
European Heart Journal 2008 29(12):1568; doi:10.1093/eurheartj/ehm622
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Left ventricular congenital submitral aneurysm
1 Department of Cardiology, Ospedale Valduce, Via Dante 11, Como 22100, Italy
2 Department of Radiology, Ospedale Valduce, Como, Italy
3 Department of Cardiac Surgery, Istituto Clinico S Ambrogio, Milano, Italy
* Corresponding author. Tel: +39 031 324111, Fax: +39 031 308047, Email: gcorr{at}iol.it
A few days after arrival in Italy from Ghana, a 20-year-old black male presented with a history of fever, headache, nausea, vomiting, and atypical chest pain. Clinical neurological evaluation, brain MNR, and cerebrospinal fluid analysis were negative for CNS disease. ECG showed normal sinus rhythm with non-specific ST-T abnormalities (Panel A). Owing to the presence of chest pain, fever and ECG abnormalities, an echocardiogram was scheduled to rule-out pericardial effusion. Echocardiogram revealed a large submitral aneurysm arising below the posterior mitral leaflet (Panel B). On 64-slice CT scan of the heart (Panel C), normal coronary arteries and a large posterior aneurism communicating with the main left ventricular cavity were observed. The patient had a successful surgical ventriculoplasty (Panel D): the neck of the aneurysm was sutured and the aneurysmal tissue was utilized to reinforce the contiguous healthy ventricular wall.
Submitral aneurysm is a peculiar form of left ventricular aneurysm thought to be caused by a congenital defect in the posterior portion of the mitral annulus and occurring almost exclusively in black Africans. Clinical presentation may include symptoms through diastolic overload (by virtue of its volume or by causing mitral annulus distortion and valve incompetence), thrombo-embolism, arrhythmias, compression of the left circumflex artery, and aneurysm rupture. Immediate surgical treatment should be considered in these patients to prevent major events.
Panel A. 12-lead ECG showing sinus rhythm with non-specific ST-T abnormalities. Panel B. 2D echocardiogram (apical long-axis view). Arrow indicates a large left ventricular aneurism of the posterior wall arising in the region between the mitral valve annulus and the posterior papillary muscle. LV, left ventricle; LA, left atrium. Panel C. Volume rendering CT scan of the heart. Arrow indicates the left ventricular posterobasal aneurysm. Panel D. Direct visualization of the left ventricular aneurysm before surgical resection.
CiteULike 
Connotea 
Del.icio.us What's this?
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||