Eur J Cardiothorac Surg 2007;32:934. doi:10.1016/j.ejcts.2007.08.028
Copyright © 2007, European Association for Cardio-thoracic Surgery. Published by Elsevier. All rights reserved.
Images in cardio-thoracic surgery |
Dissecting aneurysm of the interventricular septum following percutaneous balloon aortic valvuloplasty
Takashi Tominaga*,
Tomohisa Kawahito,
Yoshiyasu Egawa
Department of Cardiac Surgery, Kagawa National Children's Hospital, Kagawa, Japan
Received 10 July 2007;
received in revised form 24 August 2007;
accepted 31 August 2007.
* Corresponding author. Address: Department of Cardiac Surgery, Kagawa National Children's Hospital, 2603 Zentsuji-cho, Zentsuji, Kagawa 765-8501, Japan. Tel.: +81 877 65 0885; fax: +81 877 62 5384. (Email: tominaga{at}kagawasyoni.hosp.go.jp).
Key Words: CHD • Valve lesions • Cardiac catheterization/intervention • Aneurysm (other)
A 5-year-old boy was detected with dissection of the interventricular septum by magnetic resonance imaging (Fig. 1
), and underwent aortic balloon valvuloplasty for severe aortic stenosis 4 years ago in another center. The dissection progressed, and moderate aortic regurgitation and stenosis also existed. Therefore, Ross-Konno procedure was performed (Fig. 2
).
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Fig. 1. Patient came to our hospital complaining of cold. His aortic lesion was not followed up at any other hospital, and he had no past history of infective endocarditis. Dissection of the interventricular septum was detected incidentally by echocardiography, and these findings were confirmed by magnetic resonance imaging (A). The entry of dissection was located at the left ventricular–aortic junction (B). DA, dissecting aneurysm; LV, left ventricle; RVOT, right ventricular outflow tract; Ao, aorta; PA, pulmonary artery; arrow, entry.
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Fig. 2. The operative findings confirmed that the surface of the right ventricular anterior wall just below the ascending aorta was bulging (A). Under cardiopulmonary bypass, the pulmonary autograft was harvested with an extension of the infundibular free wall muscle flap, and the aortic root was transected. The dissecting cavity was exposed between the aorta and the right ventricular outflow tract, and a laceration of the left ventricular–aortic junction was noticed inside the cavity (B). The autograft was implanted into the aortic annulus, and the perforated left ventricular outflow septum was repaired with the muscle flap. The postoperative course was uneventful. DA, dissecting aneurysm; arrow, laceration; Ao, aorta; RVOT, right ventricular outflow tract.
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