Abstract
Membranous septal aneurysm (MSA) is a rare anomaly and known to cause ventricular tachycardia and atrioventricular block. However, underlying mechanisms have not been addressed in its long history. We report first 3-D electro-anatomical mapping of MSA during and three years following the surgery. An elderly patient underwent a surgery for MSA. In the mapping, we located the His bundle near MSA and observed delayed potentials around MSA. Our report showed that electrophysiological character of myocardium was changed around MSA and this change might be a reason for ventricular tachycardia and atrioventricular block. An ordinary surgery for MSA might not resolve this problem since we still observed delayed potentials three years after the surgery.
Highlights
The interventricular septum consists of muscular and membranous components
It is well known that left ventricular apical aneurysm is sometimes accompanied by delayed potentials in the myocardium around it and can be a focus of Ventricular tachycardia (VT) [6]
We speculate that stretching force due to left ventricular pressure around membranous septal aneurysm (MSA) may be a primary reason of these delayed potentials and can cause VT for MSA
Summary
Aneurysm of the membranous portion, which was first described in 1826, is a congenital structure protruding into the right ventricle and can be associated with various pathologies such as rupture, obstruction in the right ventricle and arrhythmias [1]. Ventricular tachycardia (VT) and complete atrioventricular block (AVB) were presented as complications of membranous septal aneurysm (MSA) in old reports [2] and still described as crucial problems in current literatures [3,4], only few studies performed electrophysiological investigation for MSA in its long history. A 3-D electroanatomical mapping system (CARTO) constructs a 3-D structure of the heart and draws a col-. We report the first CARTO mapping during and three years following surgery for a case of this rare pathology
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