Download Membranous Ventricular Septal Aneurysm

Images in
Cardiovascular
Medicine
Membranous Ventricular
Septal Aneurysm
Diagnosed by Means of
Cardiac Computed Tomography
Anan B. Afaneh, MD
David C. Wymer, MD
Steven Kraft, MD
David E. Winchester, MD, MS
A
53-year-old man with pulmonary arteriovenous malformations underwent
transthoracic echocardiographic testing for residual intrapulmonary shunting. An abnormal structure near the aortic annulus was noted. Further
study with cardiac computed tomography (CCT) showed an aneurysm of the membranous ventricular septum (AMS) (Figs. 1–4).
Section Editor:
Raymond F. Stainback, MD,
Department of Adult
Cardiology, Texas Heart
Institute at St. Luke’s
Episcopal Hospital, 6624
Fannin St., Suite 2480,
Houston, TX 77030
Fig. 1 Cardiac computed
tomography shows a partial
coronal view of an aneurysm
of the membranous septum
(arrow). In this image, the
left atrium, left ventricle, and
ascending aorta are opacified with iodinated contrast
medium.
From: Departments
of Internal Medicine
(Dr. Afaneh) and Radiology
(Dr. Wymer), and Division
of Cardiovascular Medicine
(Drs. Kraft and Winchester),
University of Florida,
Gainesville, Florida 32610
Address for reprints:
David E. Winchester, MD,
Division of Cardiovascular
Medicine, University of
Florida, P.O. Box 100277,
Gainesville, FL 32610
E-mail: David.Winchester@
medicine.ufl.edu
© 2012 by the Texas Heart ®
Institute, Houston
450
Membranous Ventricular Septal Aneurysm on CCT
Fig. 2 Cardiac computed
tomography. A 3-dimensional image of the heart
shows the aneurysm of the
membranous septum (arrow)
encroaching into the right
ventricle (colored in red). The
sinuses of Valsalva at the
base of the ascending aorta
and the right coronary artery
are seen just above the
aneurysm.
Volume 39, Number 3, 2012
Fig. 3 Cardiac computed tomographic 3-dimensional reconstruction, limited to the portions of the heart that contain iodinated contrast medium. The aneurysm (arrow) is seen arising
from the membranous portion of the interventricular septum just
beneath the right coronary sinus of Valsalva; the artery courses
around the right ventricle, which has been digitally removed from
the image.
the left ventricular outflow tract3 and have been diagnosed by means of angiography, echocardiography, and
magnetic resonance imaging. However, reports of the
discovery of this defect on CCT are uncommon. Although most cases do not manifest themselves symptomatically, AMS can be associated with systemic emboli,
endocarditis, cardiac arrhythmias, left or right ventricular outflow tract obstruction, and right-to-left shunts
secondary to ruptures.
Echocardiography is an effective means for the diagnosis of AMS; however, its morphologic evaluation
lacks detail. In patients with known AMS, the sensitivity of echocardiography to detect the defect in at least 2
imaging planes is 70%.4 Unlike echocardiography, cardiovascular magnetic resonance has the advantage of
being able to construct any imaging plane. Multislice
computed tomography, yet another diagnostic method for the detection of AMS, has the advantage of 3dimensional morphologic display.5
For this patient, CCT and volume imaging acquisition provided a diagnostic advantage by reason of its
multiplanar 3-dimensional reconstructions. The increasing availability of multiplanar cardiac imaging
techniques has improved the accuracy of diagnosis for
many cardiac diseases. Magnetic resonance imaging
and CCT have important roles in the evaluation of cardiac aneurysms.6
References
Fig. 4 Cardiac computed tomography. A still frame of a partial
sagittal image shows the septal aneurysm opaque with contrast
medium, but not contractile.
Real-time motion image is available at www.texasheart.org/
Click here for real-time motion image: Fig.
journal.
4.
1. Ramaciotti C, Keren A, Silverman NH. Importance of (perimembranous) ventricular septal aneurysm in the natural history of isolated perimembranous ventricular septal defect. Am
J Cardiol 1986;57(4):268-72.
2. Miyake T, Shinohara T, Nakamura Y, Fukuda T. Tasato H,
Toyohara K, Tanihira Y. Aneurysm of the ventricular membranous septum: serial echocardiographic studies. Pediatr
Cardiol 2004;25(4):385-9.
3. Meier JH, Seward JB, Miller FA Jr, Oh JK, Enriquez-Sarano M. Aneurysms in the left ventricular outflow tract: clinical presentation, causes, and echocardiographic features. J Am
Soc Echocardiogr 1998;11(7):729-45.
4. Canale JM, Sahn DJ, Valdes-Cruz LM, Allen HD, Goldberg
SJ, Ovitt TW. Accuracy of two-dimensional echocardiography in the detection of aneurysms of the ventricular septum.
Am Heart J 1981;101(3):255-9.
5. Komatsu S, Sato Y, Omori Y, Hirayama A, Okuyama Y, Kasiwase K, et al. Aneurysm of the membranous interventricular
septum demonstrated by multislice computed tomography.
Int J Cardiol 2007;114(1):123-4.
6. Shambrook JS, Chowdhury R, Brown IW, Peebles CR, Harden SP. Cross-sectional imaging appearances of cardiac aneurysms. Clin Radiol 2010;65(5):349-57.
Comment
An AMS is an uncommon congenital defect frequently found in conjunction with ventricular septal defects;
discovery might be incidental, as it was for this patient.1,2
These lesions are usually grouped with other defects of
Texas Heart Institute Journal
Membranous Ventricular Septal Aneurysm on CCT
451