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(Circulation. 2001;104:497.)
© 2001 American Heart Association, Inc.

Images in Cardiovascular Medicine

Multirow Detector Computed Tomography Assessment of Intraseptal Dissection and Ventricular Pseudoaneurysm in Postinfarction Ventricular Septal Defect

Jean-François Paul, MD; Loïc Macé, MD; Christophe Caussin, MD; Abdelhamid Fsihi, MD; Xavier Berthaux, MD; Philippe Brenot, MD; Claude Angel, MD

From the Department of Radiology, Cardiovascular Surgery and Cardiology, Centre Chirugical Marie Lannelongue, Le Plessis-Robinson, France.

Correspondence to Jean-François Paul, MD, Service de Radiologie, Centre Chirugical Marie Lannelongue, 133 avenue de la résistance, 92350 Le Plessis-Robinson, France. E-mail pauljf{at}ccml.com

A 46-year-old man had an acute inferior myocardial infarction after physical exercise. There was no evidence of heart failure. The ECG showed a 3-mm ST-T segment elevation with Q waves in leads D2, D3, and VF and a 3-mm depression in leads V2 to V4. Immediate coronary angiography evidenced a tight stenosis with distal slow flow that was located in the right coronary artery. Percutaneous transluminal coronary angioplasty, with implantation of 2 stents, was successfully performed. A normal flow was restored. Post-procedure ECG showed an isoelectric ST-T segment in leads D2, D3, and VF. Maximal creatine kinase elevation was 500 IU at 12 hours after the onset of clinical symptoms. Subsequent cardiac auscultation uncovered a loud holosystolic murmur. Color-coded Doppler echocardiography demonstrated a ventricular septal defect with a left to right shunt.

A multirow-detector computed tomography (CT, Volume Zoom, Siemens) scan procedure was performed with 4 iodine-enhanced, ECG-triggered, 1-mm slice acquisitions. Rotation time was 500 ms, accounting for a total breath-hold of 37 seconds. Diastolic gated and 3D reconstructions were performed at 70% RR intervals, with 0.6 mm increments of reconstruction. Three-dimensional reconstructions with vol-ume rendering showed both complex posterior ventricular septal rupture (Figure 1) and contiguous unsuspected pseudoaneurysm of the posteroinferior wall of the left ventricle (Figure 2).

View larger version (86K): [in this window] [in a new window]   Figure 1. Coronal view in the plane of the pulmonary artery with 3D rendering technique showing a ventricular septal defect (arrow) that was responsible for a right-to-left shunt, which was found on Doppler ultrasonography. PA indicates pulmonary artery; RV, right ventricle; and LV, left ventricle.

View larger version (84K): [in this window] [in a new window]   Figure 2. Coronal view in the plane of the aorta (Ao) showing a contiguous pseudoaneurysm (An) of the inferior septal segment of the left ventricle (LV). RV indicates right ventricle.

A biventricular endocardial patch was used for surgical repair with infarct exclusion. Recovery was uneventful. A postoperative CT scan showed that there was no residual septal defect or left ventricular aneurysm.

Footnotes

The editor of Images in Cardiovascular Medicine is Hugh A. McAllister, Jr, MD, Chief, Department of Pathology, St.Luke’s Episcopal Hospital and Texas Heart Institute, and Clinical Professor of Pathology, University of Texas Medical School and Baylor College of Medicine.

Circulation encourages readers to submit cardiovascular images to the Circulation Editoral Office, St.Luke’s Episcopal Hospital/Texas Heart Institute, 6720 Bertner Ave, MCI-267, Houston, TX 77030.

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This Article Extract Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Paul, J.-F. Articles by Angel, C. Search for Related Content PubMed PubMed Citation Articles by Paul, J.-F. Articles by Angel, C. Related Collections Acute coronary syndromes CT and MRI Acute myocardial infarction