Dissection of the interventricular septum: Echocardiographic features

Aneurysms of Aortic Sinus of Valsalva Dissecting through the Interventricular Septum With Rupture into the Left Ventricle: Case Series and Literature Review

Aneurysm of Aortic sinus of Valsalva (ASOV) dissecting into the interventricular septum (IVS) and rupturing into the left ventricle (LV) is a rare clinical diagnosis. Systemic inflammatory diseases like tuberculosis can aggravate this condition. We describe three cases of ASOV dissecting into the IVS and rupturing into the LV. All three patients underwent surgical intervention; two had a successful outcome. A literature review was conducted and19 previously reported cases were studied. The extent and direction of septal dissection determined the associated cardiac valvular and rhythm problems. Patch closure of the mouth of the aneurysm is the surgical method of choice. In the presence of multiple sinus tracts or if there is recurrence after surgical closure, aortic sinus or root replacement techniques have better outcomes.

Ventricular apical wall rupture and ventricular aneurysm formation concurrent with ventricular septal dissection and rupture due to ST-segment elevation myocardial infarction: a case report

The most common mechanical complications of acute myocardial infarction include free-wall rupture, ventricular septal rupture (VSR), papillary muscle rupture and pseudoaneurysm. It is rare for a patient to experience more than one mechanical complication simultaneously. Here, we present a case of ST-segment elevation myocardial infarction (STEMI) complicated with three mechanical complications, including ventricular apical wall rupture, ventricular aneurysm formation and ventricular septal dissection (VSD) with VSR. Cardiac auscultation revealed rhythmic S1 and S2 with a grade 3 holosystolic murmur at the left sternal border. Electrocardiogram indicated anterior ventricular STEMI. Serological tests showed a significant elevated troponin I. Bedside echocardiography revealed ventricular apical wall rupture, apical left ventricle aneurysm and VSD with VSR near the apex. This case demonstrates that several rare mechanical complications can occur simultaneously secondary to STEMI and highlights the importance of bedside echocardiography in the early diagnosis of mechanical complications.

Myocardial contrast echocardiographic diagnosis and follow-up of interventricular septal hematoma after retrograde intervention for a chronic total occlusion of a right coronary artery: a case report

BACKGROUND

Chronic total occlusion percutaneous coronary interventions (CTO-PCI) can be highly complex and are associated with an increased risk of complications. Coronary perforation (CP) is one of the most feared complications of CTO-PCI. Awareness of the potential consequence, as well as meticulous attention to patient monitoring, can aid in rapid treatment if it happens. We present a unique case covering myocardial contrast echocardiography (MCE) characterization of interventricular septal hematoma secondary to CP associated with decompression of the hematoma into the left ventricle cavity and a favorable clinical outcome.

CASE DESCRIPTION

This is a case of a patient with no space-occupying effect in interventricular septum before CTO-PCI showed severe chest pain after PCI. Bedside echocardiography showed thickening of the interventricular septum with the anechoic area, and contrast-enhanced echocardiography suggested the presence of interventricular septal hematoma and coronary-ventricular fistula. It was considered that retrograde CTO-PCI led to CP, which developed into an interventricular septal hematoma. The hematoma obstructed the right ventricular outflow tract (RVOT) to a lesser amount; at the same time, the perforated coronary artery created a fistula with the left ventricle, resulting in perfusion damage and myocardial ischemia to some extent, although the patient's vital signs remained stable. Therefore, conservative treatment was carried out under close observation. The patient stayed stable. The hematoma was absorbed 7 days after the operation, and completely absorbed 1 month later.

CONCLUSIONS

Although most cases of myocardial hematoma caused by CP can be treated conservatively without causing acute hemodynamic damage, a myocardial hematoma can progress at any time. Closely monitoring the changes in patients' symptoms and vital signs; mastering the location of the perforated coronary artery, the size of the hematoma and the hemodynamic abnormalities can help clinicians quickly make further treatment plans. Echocardiography coupled with contrast-enhanced ultrasonography, which is non-invasive, safe, cost-effective, and bedside-operable may accurately indicate the location, size of the hematoma, whether there is a shunt, as well as observe the hemodynamic changes and myocardial perfusion in real-time.

Case Report: A Giant Left-Ventricular Intramural Pseudoaneurysm Arise From Ruptured Left Sinus of Valsalva Aneurysm

In this report, we present a case study of an extremely rare left sinus Valsalva aneurysm (SVA) rupture into the left-ventricular myocardium. Acute ozone inhalation and long-term hypertension are possible contributors to the condition. Utilizing multimodal cardiovascular imaging techniques [echocardiogram, computed tomography (CT), and cardiac magnetic resonance (CMR)], a large, left-ventricular, intramural pseudoaneurysm (IPA) arising from the ruptured left SVA, was clearly observed anatomically and functionally. Subsequently, our patient underwent patch repair and valvoplasty which offered an excellent prognosis. This report describes the manifestation of the ruptured left SVA and its possible etiology. This case also emphasizes the need for multimodal imaging for subsequent surgical repair.

Multimodal imaging of a rare interventricular septum dissecting aneurysm: A case report

We report the case of a patient who presented with chest pain and palpitation, and in whom multimodality imaging, including transthoracic echocardiography, computer tomography angiogram, and coronary angiogram led to the diagnosis of interventricular septum dissecting aneurysm resulting from the rupture of a sinus of Valsalva aneurysm and paravalvular aortic root pseudoaneurysm. The patient underwent the modified Cabrol procedure in the cardiac surgery department. His ruptured sinus of Valsalva aneurysm was repaired and its communication with the pseudoaneurysm was closed. This case report highlights the role of multimodality cardiac imaging.

Complete Dissection of the Interventricular Septum Following Myocardial Infarction

In this report, we present a case of interventricular septal dissection (IVSD) following inferior wall myocardial infarction (MI) in a 64-year-old patient; the patient ultimately recovered after prompt resuscitation and intervention, despite the high mortality associated with these cases.

A 64-year-old male with a history of hypertension and obesity was brought to the hospital following an episode of syncope at home. He had been experiencing chest tightness over the past few days prior to the admission. On physical exam, he had a heart rate of 72 beats per minute and blood pressure of 73/52 mmHg. His electrocardiogram revealed ST-segment elevations in leads II, III, and aVF. Emergent coronary angiography revealed 100% occlusion of the right coronary artery (RCA) with no collateral supply and 95% stenosis of the left anterior descending (LAD) artery. Aspiration thrombectomy and balloon angioplasty and subsequent stenting of the RCA were performed. Transthoracic echocardiogram with color Doppler was performed, which confirmed the presence of a defect in the septum. Color Doppler demonstrated a clear jet entering the ventricular septum from the left ventricle (LV), with the jet traversing the entire length of the septum through a dissection and entering into the right ventricle (RV), consistent with complete IVSD. The patient subsequently underwent a successful bovine pericardial patch repair of the ventricular septum.

IVSD is a rare anomaly of the IVS. An echocardiogram is a useful tool to establish the diagnosis. The mortality rate after ventricular septal rupture remains high. Fortunately, our patient had interventricular dissection without rupture. Prompt surgical repair remains the choice of treatment for this condition.