Left Ventricular Outflow Tract Pseudoaneurysm Research Articles

Transcatheter Closure of Left Ventricular Outflow Tract Pseudoaneurysm Compressing the Left Anterior Descending Artery

Transcatheter Closure of Left Ventricular Outflow Tract Pseudoaneurysm Compressing the Left Anterior Descending Artery

Abstract 14148: Left Ventricular Outflow Tract Pseudoaneurysm in a Pediatric Patient: An Unusual Presentation of Endocarditis

Description of Case: A 12-year-old male with known bicuspid aortic valve presented with one month of progressive weight loss and subjective fevers. Transthoracic echocardiogram was concerning for a new left ventricular outflow tract (LVOT) aneurysm (figure 1). His aortic valve stenosis and regurgitation had notably progressed compared to a prior study one year ago. He was urgently referred for cardiac computed tomographic angiography (CCTA), which demonstrated a pseudoaneurysm of the LVOT inferior to the aortic valve and irregularly thickened aortic valve leaflets with a notable perforation (figure 2). Blood cultures were positive for Viridans streptococci, confirming the diagnosis of infective endocarditis. The patient was referred for a Bentall procedure with LVOT pseudoaneurysm repair. Pre-operative transesophageal echocardiogram demonstrated a communication of the non-coronary cusp of the aortic valve and LVOT. Ultimately, aortic root replacement was performed with a 23mm homograft. Our patient recovered well from surgery and now has excellent clinical status with normal aortic valve function. Discussion: Pseudoaneurysm of the LVOT as a result of infective endocarditis is a rare diagnosis, especially in the pediatric population. Of the case reports published, it is most seen in the setting of infection involving the native aortic valve but has also been reported after aortic valve replacement. As in our patient, the most commonly reported location involves the mitral-aortic intervalvular fossa. Symptoms have insidious onset and the diagnosis requires a high level of suspicion. A multimodal imaging approach is warranted for optimal diagnosis and treatment.

Left Ventricular Outflow Tract Pseudoaneurysm Compresses Left Anterior Descending Artery: A Case Report and Review of Literature

A case of a 49-year-old man with a history of buprenorphine-substituted heroin was admitted for acute heart failure after three months of bioprosthetic aortic replacement to treat infective endocarditis. Transthoracic echocardiography (TTE) showed a left ventricular ejection fraction (EF) was 35% and a periprosthetic mass with an aorto-ventricular fistula. Thoracic computed tomography revealed a left ventricular outflow tract (LVOT) pseudoaneurysm measuring 69 x 45 mm that compressed left anterior descending (LAD) artery with downstream myocardial ischemia. Patient was treated by an urgent surgery, including an exclusion of the pseudoaneurysm, a left ventricular reconstruction surgery and a bioprosthetic aortic replacement. Patient went through a difficult postoperative period. Finally, he was safely discharged with a low EF (34%) from hospital to rehabilitation center with a Life vest. This case spotlights a rare devastating complication of a LVOT pseudoaneurysm compresses LAD artery and how surgery could decompress the false aneurysm and stabilize ischemia.

An Unusual Case of Left Ventricular Outflow Tract Pseudoaneurysm

Left ventricular outflow tract (LVOT) pseudoaneurysm is a rare condition with a wide range of causes and various clinical outcomes. The causes range from infections, trauma to the chest wall, and iatrogenic origins. We present a unique case of idiopathic LVOT pseudoaneurysm in a patient with no obvious clinical risk factors. (Level of Difficulty: Advanced.)

Left ventricular outflow tract pseudoaneurysms and severe paravalvular aortic regurgitation treated by percutaneous approach in a Marfan syndrome patient

A 66-year-old male with a history of Marfan syndrome and resolved infective endocarditis was found to have shortness of breath after a previous aortic valve replacement in 2010. Several severe paravalvular leaks were seen on imaging, and left ventricular outflow tract pseudoaneurysms were identified as the cause of his symptoms which warranted treatment. Due to this patient’s risk of surgical intervention, a retrograde transaortic approach was used.

Active infective endocarditis of a bicuspid aortic valve causing left ventricular outflow tract pseudoaneurysm and right atrium shunt: A case report.

Introduction and importanceLeft ventricular outflow tract pseudoaneurysm associated with infective endocarditis is a rare but life-threatening condition.Case presentationA 68-year-old man developed infective endocarditis of a bicuspid aortic valve with suspected annulus abscess and was transferred to our department for further treatment. Cardiac workup revealed the formation of a left ventricular outflow tract pseudoaneurysm penetrating the right atrium. We successfully treated the patient with pseudoaneurysm repair using a bovine pericardium patch in combination with aortic valve replacement. The patient was uneventfully discharged after 6-week antibiotic therapy and remained well for the following 2 years.Clinical discussionSurgery is the recommended treatment for left ventricular outflow tract pseudoaneurysms. Accurate diagnosis and identification of the anatomical conditions are crucial for determining the appropriate treatment.ConclusionWhen considering the appropriate surgical treatment for left ventricular outflow tract pseudoaneurysm associated with infective endocarditis, pseudoaneurysm repair using a bovine pericardial patch and concomitant aortic valve replacement can be an effective and feasible therapeutic option.

Correction to: Culprit of Unstable Angina: A Large Left Ventricular Outflow Tract Pseudoaneurysm.

Correction to: Culprit of Unstable Angina: A Large Left Ventricular Outflow Tract Pseudoaneurysm.

Two aortic root pseudoaneurysms in infective endocarditis in a patient with bicuspid aortic valve

Infective endocarditis can cause several major complications, including valvular destruction, aneurysm formation, and aortic ring abscesses, and pseudoaneurysm formation in left ventricular outflow tract (LVOT) is quite a rare complication of infective endocarditis. Here, we present a rare case which had two simultaneous LVOT pseudoaneurysms, a bicuspid aortic valve (BAV) and abscess formation along with the presence of anerobic bacteria (Peptostreptococcus) in the tissue culture. We describe echocardiographic, computed tomography angiography findings, and the result of surgical repair. This is a unique case with 2 LVOT pseudoaneurysms, a BAV, and anerobic bacteria in the tissue culture which became complicated as a result of delayed intervention due to fear of coronavirus disease 2019.

Giant left ventricular outflow tract pseudoaneurysm presenting as anterior mediastinal mass: diagnosis by MDCT

We report a case of giant left ventricular outflow tract pseudoaneurysm diagnosed by multidetector computed tomography cardiac angiography. This report highlights the importance of preoperative computed tomography in the evaluation of left ventricular outflow tract pseudoaneurysm which can be kept as a differential diagnosis for anterior mediastinal masses.

An unusual cause of acute coronary syndrome: Left ventricular outflow tract pseudoaneurysm

An unusual cause of acute coronary syndrome: Left ventricular outflow tract pseudoaneurysm

Percutaneous Closure of a Left Ventricular Outflow Tract Pseudoaneurysm

Percutaneous Closure of a Left Ventricular Outflow Tract Pseudoaneurysm

UNUSUAL CAUSE OF ANGINA: DYNAMIC LEFT MAIN CORONARY ARTERY COMPRESSION BY LEFT VENTRICULAR OUTFLOW PSEUDO-ANEURYSM

Left ventricular outflow tract (LVOT) pseudoaneurysm (PsA) with coronary compression is an uncommon etiology for angina. This is a rare complication in patients with a history of infective endocarditis A 40-year-old male presented with intermittent fever and worsening exertional chest pain over

Dynamic Compression of the Left Coronary Artery by a Left Ventricular Pseudoaneurysm after Myocarditis.

A 69-year-old man with a recent diagnosis of suspected leptospirosis infection-related myocarditis presented with antecedent arthralgia, myalgia, fever, intermittent anterior chest pain, yellowish sclera, yellowish skin and shortness of breath. His symptoms improved after antibiotic treatment with penicillin for 14 days. However, recurrent chest pain and progressive dyspnea upon exertion developed 2 months later. A newly developed left ventricular outflow tract pseudoaneurysm was identified by cardiac sonography and multi-detector computed tomography of the heart. A subsequent coronary arteriogram demonstrated an left ventricular (LV) pseudoaneurysm causing compression to both the left circumflex coronary artery and the left anterior descending coronary artery with significant stenosis. To the best of our knowledge, this is the first reported case of a LV pseudoaneurysm developing after a clinical course of suspected leptospirosis-related myocardit is causing dynamic compression of the left coronary artery. Dynamic compression of coronary artery; Left ventricular pseudoaneurysm; Leptospirosis; Myocarditis.

The role of multidetector computed tomography for detecting aortic root pseudoanerysms complicating infective endocarditis

Echocardiography is the mainstay imaging technique for detecting infective endocarditis vegetations but may struggle to detect and characterise complicating features. There is increasing interest in the use of multidetector computed tomography (MDCT) as an adjunct to echocardiography, especially where there is concern for abscess or pseudoaneurysm formation. We present the case of a 70-year-old male with bio-prosthetic aortic valve endocarditis complicated by a large infected left ventricular outflow tract pseudoaneurysm which was diagnosed using MDCT angiography. Radiologists and clinicians should be aware of the emerging role of MDCT in this setting in order to advise and direct an appropriate imaging strategy. 

Cardiac Tamponade due to Left Ventricular Pseudoaneurysm After Aortic Valve Replacement

Left ventricular outflow tract pseudoaneurysm is a rare but a potentially lethal complication, mainly after aortic root endocarditis or surgery. Usually, it originates from a dehiscence in the mitral-aortic intervalvular fibrosa and arises posteriorly to the aortic root. We report a rare case of a patient with cardiac tamponade due to left ventricular pseudoaneurysm after aortic valve replacement. The subsequent surgical resection was performed successfully.

Pseudoaneurysm of mitral-aortic intervalvular fibrosa in a child: Demonstration by MDCT and MRI

Subaortic left ventricular outflow tract pseudoaneurysms are rare lesions that are associated with aortic valve diseases, infective endocarditis, trauma or surgery. We present dynamic multidetector computerized tomography and cine magnetic resonance imaging features of a case of subaortic aneurysm arising from interaortic-mitral valvular region in a child with past history of infective endocarditis.

Idiopathic left ventricular outflow tract pseudoaneurysm

Left ventricular outflow tract (LVOT) pseudoaneurysm is a rare occurrence and may produce clinically unpredictable symptoms. A very few cases of LVOT pseudoaneurysm are reported and there has always been a predisposing factor in these reported cases such as history of infective endocarditis, myocardial infarction, prosthetic aortic valve replacement or chest trauma. Our patient did not have the above predisposing conditions. Intra operative transesophageal echocardiography helped patient management and guided the surgical team in securing and isolation of the aneurysmal sac from the LVOT.

Percutaneous therapeutic approaches to closure of cardiac pseudoaneurysms

Cardiac and aortic pseudoaneurysms are rare complications following myocardial infarction or cardiac surgery. They are characterized by a contained cardiac or aortic rupture within surrounding tissue and have a high mortality rate if left untreated. Percutaneous treatment of cardiac pseudoaneurysms might be a feasible treatment option in patients who are at high risk of reoperative surgery. There is limited literature on the outcomes and the approaches to percutaneous treatment of these pseudoaneurysms. We review nine cases of cardiac and aortic pseudoaneurysms and percutaneous techniques for closure. Pseudoaneurysms were categorized anatomically as left ventricular posterior (posterobasal or posterolateral), left ventricular outflow tract, left ventricular apical, and ascending aortic pseudoaneurysms. Two patients with posterior pseudoaneurysms (one posterobasal treated with an Amplatzer Septal Occluder device, and one wide-mouthed posterolateral pseudoaneurysm which was not closed, are described. We further describe two left ventricular outflow tract pseudoaneurysms treated successfully with percutaneous coil embolization, one left ventricular apical pseudoaneurysm treated with coils, and three ascending aortic pseudoaneurysms treated with a septal occluder device or vascular plug. We review the technical approaches, device selection strategies, outcomes, and complications with these percutaneous treatment options. The size of the pseudoaneurysm dimensions of its neck and relative anatomy, particularly to the coronaries and valves, are critical issues to be addressed before percutaneous treatment of these pseudoaneurysms.

Left ventricular outflow tract pseudoaneurysm compromising blood flow through the left main coronary artery after mechanical aortic valve implantation

A 73-year-old male with a history of mechanical aortic valve replacement and DDD pacemaker implantation was referred to our hospital with progressive anginal complaints. Invasive coronary angiography (CA) revealed systolic compression of the left main coronary artery (LMCA), suggesting an extra-cardiac mass compromising blood flow. Single photon emission computed tomography (SPECT) and multislice computed tomography-CA (MSCT-CA) were obtained which revealed a pseudoaneurysm originating from half the circumference of the left ventricular outflow tract (LVOT) …

Resolution of thrombus in left ventricular outflow tract pseudoaneurysm mimicking periaortic abscess

Prosthetic valve complications are not uncommon after valve replacement. In this paper we report a female patient who presented with aortic prosthetic valve endocarditis and echocardiographic appearance of periaortic abscess. After 6 weeks of antibiotic therapy, echocardiographic examination revealed resolution of abscess cavity and replacement with a clear blood-filled anechoic sac. Diagnosis was made by cardiac computed tomography, which showed a left ventricular outflow tract (LVOT) pseudoaneurysm rather than an abscess, located just below the sewing ring of the prosthetic aortic valve. We assumed that either resolution of thrombus in LVOT pseudoaneurysm following effective warfarin therapy or clearance of infective content in pseudoaneurysm after co-administered antibiotics gave rise to change in echocardiographic characteristics in the perivalvular area.