(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).
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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 septum.
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Figure 2. Echocardiogram at 6 months of age (see text). A,
Apical four-chamber view demonstrates a wide-mouth aneurysm of
mid and apical portions of interventricular septum
(arrowheads) without any obvious left ventricular clots.
Right ventricular cavity was significantly obliterated by
protruding interventricular septum. Ejection fraction by
Simpson's rule was 42%, with preserved contractility
of free wall of left ventricle. B, Same ventricular
aneurysm is demonstrated in parasternal short-axis view.
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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 Dr Hugh A. McAllister, Jr, St Luke's Episcopal Hospital and Texas Heart Institute, 6720 Bertner Ave, MC1–267, Houston, TX 77030.
