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Dynamic right ventricular outflow tract obstruction caused by a large interventricular membranous septal aneurysm

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A 60-year-old female patient was evaluated for progressive dyspnoea. Twenty-six years ago, the patient underwent atrial septum defect closure and pulmonary valve commissurotomy.

Transthoracic echocardiography showed preserved left heart function with normal endocavitary dimensions and moderate aortic regurgitation (pressure half time 320 ms, vena contracta 0.6 cm, regurgitant volume 0.5 ml, effective regurgitant orifice area 0.25 cm2). Echocardiography demonstrated increased velocity (maximal 4.8 m/s, velocity time integral 122.1 cm) with pressure gradients (maximal 92 mm Hg, mean 38 mm Hg) over the right ventricular outflow tract (RVOT), which was narrowed to 0.8 cm. Transoesophageal echocardiography established the cause of the RVOT obstruction: a large (3 × 2 cm) interventricular membranous septal aneurysm (IMSA) causing dynamic infundibular obstruction (Fig. 1, and Video 1 and 2). The patient underwent aortic valve replacement and transaortic plication of the IMSA with two pledgeted sutures.

Fig. 1
figure1

Transoesophageal echocardiography. a Membranous septum aneurysm dynamically obstructing RVOT during systole. See also online videos; b RVOT Doppler tracings showing signs of stenosis (maximal gradient 92 mm Hg, mean gradient 38 mm Hg). (LA left atrium, LV left ventricle, A aorta, RV right ventricle. ***Interventricular membranous septal aneurysm)

Dynamic systolic RVOT obstruction is one of the most unusual complications associated with IMSA with only a few cases reported so far [1,2,3,4,5].

References

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    Altunbas G, Gokaslan G, Ercan S, et al. Contribution of giant aneurysm of a membranous ventricular septal defect to right ventricular outflow tract obstruction. Thorac Cardiovasc Surg. 2013;61:320–2.

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    Chen SY, Chan KL, Beauchesne LM. Right ventricular outflow tract obstruction secondary to a membranous ventricular septal aneurysm. Eur J Echocardiogr. 2011;12:886.

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    Baweja G, Nanda NC, Nekkanti R, et al. Three-dimensional transesophageal echocardiographic delineation of ventricular septal aneurysm producing right ventricular outflow obstruction in an adult. Echocardiography. 2004;21:95–7.

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Funding

This study was supported by the Serbian Ministry of Education, Science and Technological Development (III41007, ON174028)

Author information

Correspondence to L. Velicki.

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Conflict of interest

L. Velicki, D.G. Jakovljevic, A.M. Milosavljevic, M. Todic, J. Rajic and M. Fabri declare that they have no competing interests.

Caption Electronic Supplementary Material

Video 1 Transoesophageal echocardiography of RVOT at the same level as depicted in Fig. 1

Video 2 Transoesophageal echocardiography: RVOT Doppler tracings

Video 1 Transoesophageal echocardiography of RVOT at the same level as depicted in Fig. 1

Video 2 Transoesophageal echocardiography: RVOT Doppler tracings

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Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.

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Velicki, L., Jakovljevic, D.G., Milosavljevic, A.M. et al. Dynamic right ventricular outflow tract obstruction caused by a large interventricular membranous septal aneurysm. Neth Heart J 26, 575–576 (2018) doi:10.1007/s12471-018-1150-0

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