Abstract
WEBSITE FEATURE
A 53-year-old man with pulmonary arteriovenous malformations underwent transthoracic echocardiographic testing for residual intrapulmonary shunting. An abnormal structure near the aortic annulus was noted. Further study with cardiac computed tomography (CCT) showed an aneurysm of the membranous ventricular septum (AMS) (Figs. 1–4).
Fig. 1 Cardiac computed tomography shows a partial coronal view of an aneurysm of the membranous septum (arrow). In this image, the left atrium, left ventricle, and ascending aorta are opacified with iodinated contrast medium.
Fig. 2 Cardiac computed tomography. A 3-dimensional image of the heart shows the aneurysm of the membranous septum (arrow) encroaching into the right ventricle (colored in red). The sinuses of Valsalva at the base of the ascending aorta and the right coronary artery are seen just above the aneurysm.
Fig. 3 Cardiac computed tomographic 3-dimensional reconstruction, limited to the portions of the heart that contain iodinated contrast medium. The aneurysm (arrow) is seen arising from the membranous portion of the interventricular septum just beneath the right coronary sinus of Valsalva; the artery courses around the right ventricle, which has been digitally removed from the image.
Fig. 4 Cardiac computed tomography. A still frame of a partial sagittal image shows the septal aneurysm opaque with contrast medium, but not contractile.
Real-time motion image is available at www.texasheart.org/journal.
Comment
An AMS is an uncommon congenital defect frequently found in conjunction with ventricular septal defects; discovery might be incidental, as it was for this patient.1,2 These lesions are usually grouped with other defects of the left ventricular outflow tract3 and have been diagnosed by means of angiography, echocardiography, and magnetic resonance imaging. However, reports of the discovery of this defect on CCT are uncommon. Although most cases do not manifest themselves symptomatically, AMS can be associated with systemic emboli, endocarditis, cardiac arrhythmias, left or right ventricular outflow tract obstruction, and right-to-left shunts secondary to ruptures.
Echocardiography is an effective means for the diagnosis of AMS; however, its morphologic evaluation lacks detail. In patients with known AMS, the sensitivity of echocardiography to detect the defect in at least 2 imaging planes is 70%.4 Unlike echocardiography, cardiovascular magnetic resonance has the advantage of being able to construct any imaging plane. Multislice computed tomography, yet another diagnostic method for the detection of AMS, has the advantage of 3-dimensional morphologic display.5
For this patient, CCT and volume imaging acquisition provided a diagnostic advantage by reason of its multiplanar 3-dimensional reconstructions. The increasing availability of multiplanar cardiac imaging techniques has improved the accuracy of diagnosis for many cardiac diseases. Magnetic resonance imaging and CCT have important roles in the evaluation of cardiac aneurysms.6
Supplementary Material
Footnotes
Address for reprints: David E. Winchester, MD, Division of Cardiovascular Medicine, University of Florida, P.O. Box 100277, Gainesville, FL 32610, E-mail: David.Winchester@medicine.ufl.edu
References
- 1.Ramaciotti C, Keren A, Silverman NH. Importance of (perimembranous) ventricular septal aneurysm in the natural history of isolated perimembranous ventricular septal defect. Am J Cardiol 1986;57(4):268–72. [DOI] [PubMed]
- 2.Miyake T, Shinohara T, Nakamura Y, Fukuda T. Tasato H, Toyohara K, Tanihira Y. Aneurysm of the ventricular membranous septum: serial echocardiographic studies. Pediatr Cardiol 2004;25(4):385–9. [DOI] [PubMed]
- 3.Meier JH, Seward JB, Miller FA Jr, Oh JK, Enriquez-Sarano M. Aneurysms in the left ventricular outflow tract: clinical presentation, causes, and echocardiographic features. J Am Soc Echocardiogr 1998;11(7):729–45. [DOI] [PubMed]
- 4.Canale JM, Sahn DJ, Valdes-Cruz LM, Allen HD, Goldberg SJ, Ovitt TW. Accuracy of two-dimensional echocardiography in the detection of aneurysms of the ventricular septum. Am Heart J 1981;101(3):255–9. [DOI] [PubMed]
- 5.Komatsu S, Sato Y, Omori Y, Hirayama A, Okuyama Y, Kasiwase K, et al. Aneurysm of the membranous interventricular septum demonstrated by multislice computed tomography. Int J Cardiol 2007;114(1):123–4. [DOI] [PubMed]
- 6.Shambrook JS, Chowdhury R, Brown IW, Peebles CR, Harden SP. Cross-sectional imaging appearances of cardiac aneurysms. Clin Radiol 2010;65(5):349–57. [DOI] [PubMed]
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