Cases reported "Heart Aneurysm"

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1/27. Left ventricular pseudoaneurysm complicating infective pericarditis.

    Cross sectional echocardiography demonstrated a pseudoaneurysm of the left ventricular posterolateral wall close to the atrioventricular junction in a 4 year old girl with infective pericarditis complicating lobar pneumonia. Colour flow Doppler demonstrated bidirectional flow across the communication hole. Surgical resection was successful.
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2/27. Successful surgical repair of aortico-left ventricular tunnel in an infant.

    Aortico-left ventricular tunnel is a rare congenital malformation in which a perivalvular tunnel produces free communication between the aortic root and left ventricle. The hemodynamic consequences of this lesion are similar to those of aortic valve incompetence. Infants with this condition have clinical findings that should suggest it as a diagnostic possibility, and aortic root angiocardiography can establish the diagnosis. Early severe congestive heart failure is common in infants with this malformation, and in such patients prompt surgical correction of the deformity is recommended. This paper reports surgical correction of aortico-left ventricular tunnel in a 9-month-old child, the first reported patient to be successfully operated on before age 2 years.
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3/27. Giant pseudoaneurysm of the right ventricular outflow tract after repair of truncus arteriosus: evaluation by MR imaging and surgical approach.

    One year after surgical repair of the truncus arteriosus, a 1-year 8-month-old boy was found to have a pseudoaneurysm of the right ventricular outflow tract (RVOT). Cine-magnetic resonance imaging (MRI) showed a narrow communication between the RVOT and aneurysm. MRI was useful to evaluate the anatomical and spatial relations between the pseudoaneurysm and the surrounding structures, therefore an appropriate approach was chosen. Thus, a median sternotomy approach was carried out and ordinary central cannulation was feasible to establish a cardiopulmonary bypass. The defect was successfully repaired with reconstruction using a monocuspid outflow patch. MRI provided useful information for deciding the surgical approach.
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4/27. Echocardiographic diagnosis and follow-up of left ventricular pseudoaneurysm complicating bacterial pericarditis.

    Two-dimensional echocardiography demonstrated a pseudoaneurysm of the lateral wall of the left ventricle in a 13-year-old girl with bacterial pericarditis. The echocardiographic findings included a 5-mm discontinuity in the lateral wall of the left ventricle, an associated anechoic collection (5.6 x 5.1 cm), and a narrow communication between the left ventricle and the anechoic collection. color Doppler imaging demonstrated flow through the communication between the left ventricle and the aneurysmal cavity. The patient and her family refused surgery. A follow-up echocardiographic examination more than 6 years later demonstrated disappearance of the discontinuity of the left ventricular lateral wall, no flow between the left ventricle and the pseudoaneurysm, and thrombus formation within the pseudoaneurysm.
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5/27. Max brodel: illustrating healed valve ring abscesses.

    A 14-year-old adolescent girl presented with severe congestive heart failure, progressive throughout 3 months. A precordial thrill, machinery-like murmur, and right bundle branch block were noted. death occurred despite digitalis and diuretic therapy and removal of pleural and ascitic fluid. The autopsy revealed 2 multilocular cystic structures in the interventricular septum consistent with being spontaneously drained valve ring abscesses. One of these lesions formed a fistulous communication that penetrated through the interventricular septum between the right aortic sinus of valsalva and the crista supraventricularis that connected to the right ventricle. Another lesion, an adjacent separate but similar cystlike structure, communicated only with the left ventricular cavity. Although the cause of these lesions is uncertain, it seems probable that they are the residue of spontaneously drained and healed valve ring abscesses. Max Brodel, a medical illustrator and the first director of the Department of Art as Applied to medicine at The Johns Hopkins University, drew previously unpublished figures of this patient's cardiac lesions. These illustrations exhibit Brodel's superb command of both art and medicine essential to his ability to make complex anatomic relationships demonstrable. We discuss Brodel's career and his influence on both the art and science of medicine.
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6/27. Cross-sectional echocardiographic diagnosis of a congenital aneurysm of the muscular interventricular septum.

    An 18-year-old asymptomatic male patient was detected to have a precordial systolic murmur since early childhood. A cross-sectional and Doppler echocardiographic examination revealed a congenital aneurysm of the trabecular portion of the muscular interventricular septum with a pin-hole communication with the right ventricular cavity.
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7/27. Post-infarction communication between a left ventricular aneurysm and the right atrium.

    A 70-year-old patient presented with ventricular tachycardia and left ventricular failure. He was found to have a communication between a posterior left ventricular aneurysm and the right atrium. The causal myocardial infarction had been silent. This defect was satisfactorily closed at operation from which he made an uneventful recovery. This is the first report of a left ventricular-right atrial communication developing in association with ischaemic heart disease and highlights the role of transoesophageal echocardiography in the diagnosis and surgical management of such a condition.
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8/27. Left ventricle-to-ascending aorta communication complicating composite graft repair undetected by aortography: diagnosis by transesophageal echocardiography.

    A 57-year-old man underwent composite ascending aortic conduit and prosthetic aortic valve repair of a sinus of valsalva aneurysm. The patient's course was complicated by recurrent aneurysm formation caused by a communication between the left ventricular outflow tract and the ascending aorta outside the conduit. Transesophageal echocardiography documented the anatomic and functional characteristics of this complication, whereas aortography failed to demonstrate them. Findings at surgery confirmed the transesophageal echocardiogram results of a left ventricular outflow tract to aorta communication, a normal prosthetic aortic valve, and an intact distal anastomosis of the conduit with the aorta. Transesophageal echocardiography is a useful modality for the evaluation of composite graft repairs of the aortic valve and ascending aorta.
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9/27. Pseudoaneurysm of the left ventricle following mitral valve replacement. Report of two cases and review of the literature.

    Two cases of left ventricular (LV) pseudoaneurysm following mitral valve replacement (MVR) are presented. In one patient the false aneurysm developed after an initially successful correction of intraoperative left ventricular wall rupture while the other case resulted from an apparently uncomplicated MVR performed because of staphylococcal endocarditis. Both cases were detected by combined 2-dimensional and Doppler echocardiography. The operative treatment was similar in both patients. After extirpation of the old prosthesis, the orifice of the pseudoaneurysm was closed from inside the heart, either with a Dacron patch or using interrupted sutures supported by a teflon pledget. One of the patients died one month postoperatively but the other one recovered and is clinically well 6 months after repair. She has, however, a residual communication between the LV and the pseudoaneurysm.
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10/27. Cardiogastric fistula occurring 9 years after resection of left ventricular aneurysm.

    An 83-year-old man, 9 years after repair of a postinfarction aneurysm of the left ventricle, developed fever, anemia, and congestive heart failure. Extensive evaluation of the gastrointestinal tract revealed no evidence of ulcer disease. While in the hospital, he developed massive hematemesis and melena and died 2 days later. At autopsy, a communication existed between a left ventricular pseudoaneurysm and the stomach to form a cardiogastric fistula. infection of the left ventricular pseudoaneurysm may have precipitated the gastric perforation. This represents an extremely rare late complication of aneurysmectomy procedures and, to our knowledge, is the first case to be reported in the absence of primary gastrointestinal pathology.
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