Multimodality cardiac imaging of submitral left ventricular aneurysm with concurrent descending aorta mycotic aneurysm

Abstract

We present a case of a 20-year-old Malay man with underlying tuberculous (TB) lymphadenitis who presented with shortness of breath and found to have submitral left ventricular aneurysm (SLVA). SLVA is well recognised but rare. Incidence of SLVA in Malay has never been documented. This is the first reported case of SLVA in Malays with concomitant thoracic aorta mycotic aneurysm. TB has been reported to be associated with SLVA. Treatment is either surgical or conservative. Imaging is required for diagnosis and preoperative assessment. Multimodality imaging include echocardiography (ECHO), cardiac CTangiography and the robust multiparametric cardiac MR (CMR). ECHO is the first line imaging and useful for initial detection of the aneurysm. CMR including the late gadolinium enhancement allows excellent visualisation of the LV aneurysm, tissue characterisation, cardiac function and detection of associated pathology as shown in this case.

Case Report: Challenges in the etiology of left ventricular aneurysm

“…Infectious serology screening, including serology for Trypanosoma cruzi, was negative. As a reminder, the patient had a history of invasive systemic tuberculosis, and the aneurysm may be consistent with a mycotic aneurysm as a complication of systemic tuberculosis 3 . However, the CMR did not showed any arguments in favor of a left ventricular aneurysm secondary to a myocarditis, such as gadolinium late enhancement.…”

Surgical Management of Submitral Aneurysm

“…Magnetic resonance imagery has shown to be of great help in making the diagnosis in this case. 10, 11 It has emerged as the preferred non-invasive modality for the assessment of all the anatomical and morphological features of a submitral aneurysm. 9 The clinico-imageological correlation was good as seen in the operation theatre after cardiotomy.…”

Aneurisma subvalvar mitral: actualizando lo que sabemos en el jubileo de diamante de la enfermedad

“…Fueron denominados aneurismas subvalvares porque se encontraban justo bajo las valvas aorta y mitral, y anulares porque las cavidades aneurismáticas se extendían en dirección circular al rededor del anillo fibroso que sustentaba las valvas. La forma aórtica es mucho más rara, constituyendo menos de ¼ de los casos documentados, y hoy el término es utilizado casi exclusivamente para los aneurismas submitrales 5 .…”

“…Una vez que la ASM es una enfermedad relativamente rara, no hay datos concluyentes sobre la prevalencia e incidencia de esta condición en la población general. Actualmente, debido a las migraciones, debería ser considerada como una etiología probable de insuficiencia mitral entre paciente jóvenes en todo el mundo 5 .…”

“…La RMN Ha sido un método invasivo emergente para la evaluación de la forma y tamaño del aneurisma y de la función sistólica del ventrículo izquierdo. Por su capacidad de caracterización tisular, consigue distinguir entre pericardio, trombo y miocardio, siendo una estrategia importante en el diagnóstico diferencial con pseudoaneurisma de origen isquémico, además de genera información sobre inflamación, perfusión, viabilidad (Figura 8) 16 .…”