Dear Sir,
A 35-year-old male was admitted with a history of palpitations and breathlessness for 2 years. Because of pansystolic murmur of mitral insufficiency and a history of shortness of breath, an echocardiogram was performed which revealed sub-mitral aneurysm (SMA) of size 2.4 cm × 1.3 cm communicating with the left ventricular (LV) cavity at the level of medial aspect of mitral annulus [Figures 1 and 2]. The communication of aneurysm to the LV was through a wide neck [Figure 3]. Severe mitral regurgitation was also noted [Figure 4]. Intraoperatively, bulky fibrotic trabeculations were seen adherent to P1/P2/P3 segmental annulus, and aneurysm was below the P3 segment. Sub-mitral fibrotic area was covered with a pericardial patch and mechanical mitral prosthetic valve was inserted [Figure 5].
Figure 1.
Transesophageal echocardiography 2 chamber view showing subvalvular aneurysm
Figure 2.
Transesophageal echocardiography 4 chamber view showing subvalvular aneurysm
Figure 3.
Transesophageal echocardiography 2 chamber transgastric view showing subvalvular aneurysm
Figure 4.
Transesophageal echocardiography 2 chamber view showing severe mitral regurgitation
Figure 5.
Transesophageal echocardiography 2 chamber transgastric view showing pericardial patch closing subvalvular aneurysm
Subvalvar LV aneurysm is an uncommon, nonischemic LV aneurysm. It is mostly reported in African population with an estimated incidence of 34/10,000 cardiovascular illnesses.[1] SMA is a congenital defect in LV wall resulting in outpouching of the wall near to the posterior mitral leaflet.[2] Posterior mitral leaflet is attached to the myocardium by mitral annular fibrous ring. Defect of this fibro-muscular junction results in subvalvular aneurysm below the posterior leaflet.[3] Such aneurysm causes distortion of annulus and subvalvular apparatus with resultant secondary mitral regurgitation. Subvalvar aneurysm can have potentially dreadful complications such as aneurismal rupture causing cardiac tamponade and aneurismal compression causing coronary artery obstruction and acute myocardial ischemia.[4] Surgical repair of aneurysm is preferred.
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REFERENCES
- 1.Ruiz D, Domingo P, Canals E, Mata J. Annular submitral left ventricular aneurysm. Eur Heart J. 1992;13:424–5. doi: 10.1093/oxfordjournals.eurheartj.a060186. [DOI] [PubMed] [Google Scholar]
- 2.Antunes MJ. Submitral left ventricular aneurysms. Correction by a new transatrial approach. J Thorac Cardiovasc Surg. 1987;94:241–5. [PubMed] [Google Scholar]
- 3.Chesler E, Mitha AS, Edwards JE. Congenital aneurysms adjacent to the annuli of the aortic and/or mitral valves. Chest. 1982;82:334–7. doi: 10.1378/chest.82.3.334. [DOI] [PubMed] [Google Scholar]
- 4.Cheng TO. Submitral aneurysm is not a false aneurysm. Circulation. 1999;100:212–3. [PubMed] [Google Scholar]
