IMAGE FOCUS doi:10.1093/ehjci/jey033 .................................................................................................................................................... 1 2 1 1 1 Taichi Sakaguchi *, Satoshi Akagi , Toshinori Totsugawa , Kentaro Tamura , and Arudo Hiraoka Department of Cardiovascular Surgery, The Sakakibara Heart Institute of Okayama, 2-5-1 Nakai-cho, Kita-ku, Okayama City, 700-0804 Okayama, Japan; and Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama City, 700-8558 Okayama, Japan * Corresponding author. Tel: 181 (86) 225 7111; Fax: 181 (86) 223 5265. E-mail: email@example.com An asymptomatic 28-year-old woman with no known significant medical history was referred to us for further evaluation be- cause of abnormal chest radiograph find- ings. Echocardiography revealed an ostium secundum atrial septal defect (ASD) and right ventricular (RV) pseudoaneurysm, which were confirmed by computed tom- ography. The aneurysm became larger dur- ing systole (Panel A, arrowheads) and smaller during diastole (Panel B,arrow- heads), due to bidirectional blood flow through its neck (see Supplementary data online, Video S1). Considering the future risk of aneurysm rupture, surgical interven- tion was recommended. The patient under- went a video-assisted surgical repair for the ASD and RV pseudoaneurysm via bilateral mini-thoracotomies. Intraoperatively, thick- ened whitish epicardial tissue was unex- pectedly found covering the entire heart (Panel C), which was dissected, and the an- eurysm with a thin wall was closed (Panel D). Pathohistological findings confirmed a myocardium defect in the aneurysmal wall and fibrous hypertrophy of the epicardium, consistent with an RV pseudoaneurysm and past effusive pericarditis. An earlier incident causing a remote chest contusion was con- firmed later by interview. An RV pseudoaneurysm is an extremely rare condition occurring as a late complica- tion of catheter injury, cardiac trauma, myocardial infarction, or cardiac surgery. Although optimal management remains unclear, its rupture can be lethal. In the present case, the aneurysmal wall was very thin, and expansion and shrinkage were seen during each cardiac cycle, thus aggressive treatment may be necessary even for asymptomatic patients. Effusive pericarditis accompanied the condition in our patient and required pericardiectomy, thus a thorough preoperative examination is important for proper treatment of this rare condition. Supplementary data are available at European Heart Journal – Cardiovascular Imaging online. Published on behalf of the European Society of Cardiology. All rights reserved. V The Author(s) 2018. For permissions, please email: firstname.lastname@example.org. Downloaded from https://academic.oup.com/ehjcimaging/advance-article-abstract/doi/10.1093/ehjci/jey033/4898135 by Ed 'DeepDyve' Gillespie user on 07 June 2018
European Heart Journal – Cardiovascular Imaging – Oxford University Press
Published: Feb 21, 2018
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