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Logo of thijTexas Heart Institute JournalSee also Cardiovascular Diseases Journal in PMCSubscribeSubmissionsTHI Journal Website
 
Tex Heart Inst J. 2010; 37(5): 610–611.
PMCID: PMC2953213
WEBSITE FEATURE

Mass-Like Aneurysm of the Left Ventricular Outflow Tract

Raymond F. Stainback, MD, Section Editor
Department of Adult Cardiology, Texas Heart Institute at St. Luke's Episcopal Hospital, 6624 Fannin St., Suite 2480, Houston, TX 77030

A 24-year-old man was referred to our department for routine follow-up due to a small perimembranous ventricular septal defect (VSD), which had been monitored since his childhood. The patient's vital signs were stable. Auscultation revealed a systolic murmur. Echocardiography showed a highly mobile aneurysmal mass in the left ventricular outflow tract without stenosis or significant aortic insufficiency; there was no flow inside the mass, which appeared to be cystic (Figs. 1 and and2).2). Neither color-flow nor Doppler echocardiographic study showed evidence of left ventricular outflow tract obstruction, yet the VSD was closed.

figure 25FF1
Fig. 1 Two-dimensional echocardiogram (parasternal long-axis view) shows the left ventricular outflow tract aneurysm (arrow) within the left ventricle.
figure 25FF2
Fig. 2 Two-dimensional echocardiogram (5-chamber view) shows the left ventricle and the aneurysmal mass (arrowheads) in the region of the subaortic outflow tract.

Comment

Ventricular septal defects occur in 20% to 25% of patients who have congenital heart disease.1 The various types of VSD are perimembranous, muscular, inlet, outlet,2 and membranous; this last is the most common form in adults.1 During childhood, some patients have VSDs that close spontaneously by means of aneurysm formation in the septum adjacent to the tricuspid valve. Perhaps the cystic mass in our patient was the result of late aneurysm formation. It appeared to be a tiny, fibrous subaortic mass, too small to obstruct the outflow tract itself but large enough to close the VSD. Because this mass did not cause stenosis or substantial aortic insufficiency, we recommended medical follow-up for this patient: prophylaxis for possible infective endocarditis and routine echocardiography to monitor the progress of aortic insufficiency.

Supplementary Material

Video for Fig. 1:
Video for Fig. 2:

Footnotes

Address for reprints: Maryam Moshkani Farahani, MD, Department of Echocardiography, Baqiatallah University of Medical Sciences, No. 477, Block 18, Shahrak-e-Pass, Sheikh Fazlollah Noori Highway, Tehran 1464894793, Iran

E-mail: moc.oohay@inaharaf;f5000x#&inakhsom

References

1. Oh JK, Seward JB, Tajik AJ. The echo manual. 3rd ed. Philadelphia: Lippincott Williams & Wilkins; 2007. p. 338–9.
2. Webb GD, Smallhorn TJ, Redington AN. Congenital heart disease. In: Libby P, Bonow RO, Mann DL, Zipes DP, editors. Braunwald's heart disease: a textbook of cardiovascular medicine. 8th ed. Philadelphia: Elsevier Saunders, 2007. p. 1583.

Articles from Texas Heart Institute Journal are provided here courtesy of Texas Heart Institute