Isolated Ventricular Septal Aneurysm: A Differential Diagnosis for a Right Sinus of Valsalva Aneurysm

Abstract

Patient: Male, 42-year-old Final Diagnosis: Ventricular aneurysm Symptoms: Palpitations Medication: — Clinical Procedure: — Specialty: Cardiology Objective: Congenital defects/diseases Background: A ventricular septal aneurysm (VSA) is rare and almost always an incidental finding on cardiac imaging. It is rarely an isolated phenomenon and is more commonly associated with other forms of congenital heart disease such a ventricular septal defect (VSD). Differentiating a ventricular septal aneurysm from an aneurysm of the right sinus of Valsalva is crucial as the latter usually has a more aggressive course and may require surgical intervention. Cardiac computed tomography (cardiac CT) or cardiac magnetic resonance imaging (CMR) may help confirm the diagnosis. Case Report: We report a case of a 42-year-old obese Japanese man with a past medical history of hyperlipidemia who described occasional effort-related palpitations when climbing stairs over the past few months but no anginal symptoms. Echocardiogram revealed normal left ventricular systolic with a presumed right sinus of Valsalva aneurysm measuring around 1.5 cm. A coronary CTA was obtained to further delineate the aneurysm and revealed normal CT angiographic appearance of a right dominant coronary artery circulation with a small aneurysmal outpouching of the membranous ventricular septum measuring 13×17 mm without any evidence of shunting, along with focal calcification of the medial aspect of the tricuspid annulus. The right sinus of Valsalva appeared normal on coronary CTA. Conclusions: Membranous ventricular septal aneurysm is a rare condition that is almost always an incidental finding on echocardiography and can be mistaken for an aneurysm of the right sinus of Valsalva. Multimodality imaging and high degree of clinical suspicion are needed to accurately diagnose a ventricular septal aneurysm and to achieve favorable outcomes. A VSA usually has a benign course and is rarely a cause of arrythmia, right ventricular outflow obstruction, or valvular insufficiency.

[Retracted] Study on Inflammatory Factors in Aneurysmal Perimembranous Ventricular Septal Defect in Congenital Heart Disease

“…The formation of true perimembranous aneurysm is due to the failure to close the fetal membranous ventricular septum in time after birth, the closure of the membranous portion is delayed after birth, and part of the generated membranous portion is continuously pressed under the left ventricular high pressure to form perimembranous aneurysm, leaving the top of the tumor, and the breach causes a left-to-right shunt at the ventricular level. Another common perimembranous aneurysm VSD is the so-called pseudoperimembranous aneurysm, which is a relatively immature fibrous tissue formed by the continuous proliferation and adhesion of the tricuspid valve septum, chordae tendineae, or surrounding tissue [7][8][9]. Previous study has shown that under the condition of left-to-right shunting of intraventricular blood at the level of VSD chamber, long-term high pressure impacted the inferior membrane defect, causing damage to the perimembranous tissue and the gap of the true perimembranous aneurysm.…”

A case report of successful transaneurysmal repair of a giant isolated membranous ventricular septal aneurysm

“…The literature consists of an ample amount of data on MVSA secondary to VSD, but there are very few publications related to isolated MVSA and none regarding management of such lesions. Assaf et al 4 reported a case of a 42-year-old patient with a 1.3 cm × 1.7 cm isolated MVSA associated with no gross complications who did well with serial echocardiography monitoring. Colangelo et al .…”