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(Circulation. 1998;98:1697.)
© 1998 American Heart Association, Inc.

Images in Cardiovascular Medicine

Left Ventricular Septal Aneurysm

Anne I. Dipchand, MD; ; Christine Boutin, MD

From the Division of Cardiology, Department of Pediatrics, the Hospital for Sick Children, and Department of Pediatrics, University of Toronto, Faculty of Medicine, Toronto, Ontario, Canada.

Correspondence to Anne I. Dipchand, MD, Division of Cardiology, Hospital for Sick Children, 555 University Ave, Toronto, Ontario, Canada M5G 1X8.

A6-month-old girl (3.5 months corrected, born at 28 weeks gestational age) presented with a history of increasing tachypnea, diaphoresis, difficulty feeding, and poor weight gain. A 15-lead ECG done on day 41 of life had revealed normal sinus rhythm with a nonspecific intraventricular conduction delay. At that time, clinically there was a soft systolic murmur and no evidence of congestive heart failure. An echocardiogram revealed a structurally normal heart with a moderate-size patent ductus arteriosus shunting left to right, a small secundum atrial septal defect shunting left to right, and mildly reduced left ventricular function secondary to a dyskinetic interventricular septum (Figure 1). She was discharged clinically well at 3 months of age (corrected age, 40 weeks). On this subsequent presentation, she manifested clinical signs of mild congestive heart failure with tachypnea, fine inspiratory crackles, an intermittent gallop, and a liver palpable at 2 to 3 cm below the costal margin. A chest radiograph revealed moderate cardiomegaly with pulmonary congestion. The ECG revealed normal sinus rhythm with first-degree atrioventricular block and nonspecific intraventricular conduction delay. Transthoracic echocardiography revealed an aneurysm of the interventricular septum (Figure 2).

View larger version (40K): [in this window] [in a new window]   Figure 1. Echocardiogram at 41 days of age (see text). A, Apical four-chamber view demonstrates a normal-size left ventricle without any evidence of aneurysmal dilatation of interventricular septum. On real-time imaging, mild dyskinesis of interventricular septum was demonstrated. B, Parasternal short-axis view demonstrates a normally shaped, nondilated left ventricle. There is normal interventricular septal curvature without obvious thinning or deformation of interventricular . . . [Full Text of this Article]