Subepicardial Aneurysm Evaluated by Multiplane 2D and Real-Time 3D Volumetric Transesophageal Echocardiography

Abstract

A 76-year-old man with a history of hypertension, dyslipidemia, and 90 pack-year smoking, presented to his primary care physician with complaints of worsening dyspnea. His ECG finding did not show any pathological Q-wave or ST-T abnormalities (Online Figure I). A 2D transthoracic echocardiogram revealed normal left ventricular (LV) systolic function with inferior and inferolateral wall motion abnormalities. A suspicious aneurysm was also noted (Figure 1). His adenosine stress nuclear perfusion images showed a moderate-sized area of ischemia or jeopardized myocardium involving the infero-lateral LV (Online Figure II). He underwent cardiac catheterization, which revealed an occluded right coronary artery and significant left-to-right collaterals (Figure 2). Left ventriculography revealed a hypokinetic basal inferior wall and an aneurysm (Figure 3, Movie I). A follow-up transesophageal echocardiogram was performed using an x7–2t …