Posterior Left Ventricular Pseudoaneurysm After Aortic Valve Replacement in a Patient With Rheumatoid Arthritis: Diagnosis by Transesophageal Echocardiography

1994 ◽  
Vol 7 (4) ◽  
pp. 429-433 ◽  
Author(s):  
Dylmitr Rittoo ◽  
George R. Sutherland
Keyword(s):  
Rheumatoid Arthritis ◽  
Aortic Valve ◽  
Aortic Valve Replacement ◽  
Transesophageal Echocardiography ◽  
Valve Replacement ◽  
Left Ventricular ◽  
Rheumatoid Arthritis Diagnosis ◽  
Left Ventricular Pseudoaneurysm

scholarly journals P252 Incidental finding of a chronic left ventricular pseudoaneurysm years after surgical aortic valve replacement

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
G Klappacher ◽  
D Beitzke
Keyword(s):  
Aortic Valve ◽  
Left Ventricle ◽  
Aortic Valve Replacement ◽  
Valve Replacement ◽  
Peak Velocity ◽  
Thrombus Formation ◽  
Left Ventricular ◽  
Left Ventricular Pseudoaneurysm ◽  
Mechanical Aortic Valve ◽  
Left And Right

Abstract Case presentation A 35-years old female was referred to our outpatient clinic with unclear thoracic pain and dyspnea. Clinical chemistry testing was unremarkable. Electrocardiography (ECG) showed T-wave inversion in the anterior-lateral leads. Chest X-ray displayed an oval bulge on the left border of the heart. The physical exam revealed a systolic murmur on top of the closing click sound of a mechanical aortic valve prothesis which had been implanted nine years ago. Since that time, the patient had not had regular checkups and the actual consultation was motivated by her aggravating symptoms only. Findings. In transthoracic echocardiography, the mechanical aortic valve prothesis exhibited an acceptable peak velocity of 2.7 m/s with a mean gradient of 18 mm Hg and only mild paravalvular regurgitation. The native mitral and tricuspid valves were functionally and morphologically normal. Left and right ventricle were of normal systolic and diastolic function and normal size. No signs of pericardial effusion were detected. However, a big (40x22mm) saccular structure with a narrow (10 mm) neck was visible at the apex of the left ventricle, see left panel of figure. At the neck, a bidirectional flow between the saccular structure and the left ventricle was detected with a peak velocity of 2,5 m/sec indicating the presence of a pseudoaneurysm. Its linings were calcified and free of discernable thrombus formation, although the flow inside was turbulent as evidenced in the contrast echocardiogram, see right panel of figure. Subsequently, CT-imaging confirmed the diagnosis and surgical resection of the pseudoaneurysm was successfully performed 10 days later. The surgeon noted that the walls of the resected cavity contained thrombotic masses despite respective negative findings on CT and echo. The postoperative course was uneventful, and the patient was discharged in good condition with normal left and right ventricular function and no regional left ventricular wall abnormalities. A year later, she was however re-admitted with prosthetic aortic valve stenosis due to thrombus formation on one the leaflets in the second trimester of a pregnancy. Discussion This is an exceptional case of chronic left ventricular pseudoaneurysm following aortic valve replacement. Since the patient had no history of myocardial infarction or of other potential causes that could explain the formation of a pseudoaneurysm, it is likely to be a remnant of venting the left ventricle during the original surgical procedure. The patient had been unattended and asymptomatic for several years which allowed chronification as indicated by the calcifications of the inner linings. Still, immediate surgical repair was mandatory due to the high risk of rupture and thromboembolism. Abstract P252 Figure.

scholarly journals Incidental Left Atrial Blood Cyst in a Patient Undergoing Transcatheter Aortic Valve Replacement

2015 ◽  
Vol 42 (1) ◽  
pp. 58-60 ◽  
Author(s):  
Gregory Suero ◽  
Moneal Shah ◽  
Rachel Hughes-Doichev
Keyword(s):  
Aortic Valve ◽  
Aortic Stenosis ◽  
Aortic Valve Replacement ◽  
Transesophageal Echocardiography ◽  
Valve Replacement ◽  
Transcatheter Aortic Valve Replacement ◽  
Severe Aortic Stenosis ◽  
Left Ventricular ◽  
Transcatheter Aortic Valve ◽  
Valvular Stenosis

Blood cysts of the heart are benign cardiovascular tumors found incidentally in approximately 50% of infants who undergo autopsy at less than 2 months of age. These congenital cysts, frequently present on the atrioventricular valves of infants, are exceedingly rare in adults. Nonetheless, in adults, cardiac blood cysts have been found on the mitral valve, papillary muscles, right atrium, right ventricle, left ventricle, and aortic, pulmonic, and tricuspid valves. Reported complications include left ventricular outflow obstruction, occlusion of the coronary arteries, valvular stenosis or regurgitation, and embolic stroke. In high-risk patients with severe aortic stenosis, transcatheter aortic valve replacement has emerged as an alternative to surgical replacement. Transesophageal echocardiography plays a fundamental role in evaluating the feasibility of intraprocedural transcatheter aortic valve replacement, in measuring aortic annular size, in guiding placement of the prosthetic device, and in looking for possible complications. The embolic risk of rapid pacing and transcatheter aortic valve replacement in a patient with an intracardiac blood cyst is unknown, and such a case has not, to our knowledge, been reported heretofore. We present the case of a 78-year-old woman with severe aortic stenosis, in whom a blood cyst was incidentally found in the left atrium upon transesophageal echocardiography. She underwent successful transcatheter aortic valve replacement without embolic complication.

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