ANEURYSM OF THE VENTRICULAR SEPTUM

 

 

Congenital aneurysms of the heart have a prevalence of 0.05 in 10 000 births (1).

When the ventricles are involved, the aneurysms may be located in the:

·        cardiac apex (51%),

·        the ventricular walls (41%)

·        the ventricular septum (8%) (2).

·        the aneurysmatic tissue can involve the: membranous (3) or muscular (4,5) portion of the septum.

·        Congenital aneurysms of the membranous portion of the septum have been reported in neonates(3,6) infants (6,7) and adults(8), but not in fetuses.

·        Aneurysms of the membranous portion of the ventricular septum can be associated with complications such as right outflow tract obstruction(11-13) aortic valve prolapse (8) spontaneous rupture (3,10), tricuspid insufficiency, bacterial endocarditis (8) and cerebral infarction secondary to embolism (28)], spontaneous rupture (3,10)

·        Congenital aneurysms of the membranous portion of the ventricular septum have been reported in isolation (14) or associated with other cardiac anomalies such as aortic stenosis (15), atrial septal defects or VSDs, pulmonary stenosis, coarctation of the aorta, anomalous pulmonary venous return and persistent left superior vena cava (8), as well as in association with chromosomal abnormalities (8) and genetic syndromes (5,16)

·        Aneurysms of the membranous portion of the ventricular septum have been proposed to be secondary to the abnormal development of the endocardial cushions (17).

·        Congenital aneurysms involving the muscular portion of the ventricular septum have been identified both antenatally (5,9)] and postnatally (4)

 

 

The membranous portion of the ventricular septum is divided by the insertion of the septal leaflet of the tricuspid valve into two compartments:

(1)   the AV (between the right atrium and left ventricle

(2)   the interventricular components (18).

 

 

 

 

REFERENCES

 

  1. Hamaoka K, Onaka M, Tanaka T, Onouchi Z. Congenital ventricular aneurysm and diverticulum in children. Pediatr Cardiol 1987; 8: 169-175.
  2. Papagiannis J, Van Praagh R, Schwint O, D'Orsogna L, Qureshi F, Reynolds J, Kallfelz C, Nozar J. Congenital left ventricular aneurysm: clinical, imaging, pathologic, and surgical findings in seven new cases. Am Heart J 2001; 141: 491-499.
  3. Pedra CA, Yoo SJ, Soderberg B, Freedom RM. Aneurysm of the membranous septum in critical pulmonary stenosis: spontaneous rupture after balloon dilatation. Pediatr Cardiol 2001; 22: 359-362.         
  4. Eriksson H, Cooper SM, Rosenbaum KN, Ruckman RN. Familial occurrence of congenital aneurysm of the muscular interventricular septum. Pediatr Cardiol 1998; 19: 249-252.
  5. Fujiwara M, Sase M, Kondou O, Furukawa S. Congenital aneurysm of the muscular interventricular septum in a fraternal case diagnosed by fetal echocardiography. Pediatr Cardiol 2001; 22: 353-356.
  6. Varghese PJ, Izukawa T, Celermajer J, Simon A, Rowe RD. Aneurysm of the membranous ventricular septum. A method of spontaneous closure of small ventricular septal defect. Am J Cardiol 1969; 24: 531-536.
  7. Prabhakar G, Kumar N, al Oufi S, DeMoor M, al Halees Z, Duran MG. Congenital aneurysm of the muscular interventricular septum. Eur Heart J 1993; 14: 1294-1296.
  8. Yilmaz AT, Ozal E, Arslan M, Tatar H, Ozturk OY. Aneurysm of the membranous septum in adult patients with perimembranous ventricular septal defect. Eur J Cardiothorac Surg 1997; 11: 307-311.
  9. Donofrio MT, Allen DR, Tekin M, Bodurtha J. Autosomal dominant myocardial disease diagnosed by fetal presentation of proband with an aneurysm of the muscular interventricular septum. Pediatr Cardiol 2002; 23: 27-31.
  10. Magherini A, Schmidtlein C, Urciuolo A, Tomassini CR, Calzolari A, Rorani C, Machetti G, Martinelli R, Vizzoni L, Bartolozzi G. Congenital aneurysm of the interventricular muscular septum with rupture into the right ventricle in a child. Am Heart J 1988; 116: 185-187.
  11. Di Benedetto G, Crupi GC, Villani M, Abbruzzese P, Parenzan L, Pacifico AD. Left ventricular outflow tract obstruction due to an aneurysm of the membranous septum in a patient with pulmonary atresia and ventricular septum defect - case report. Thorac Cardiovasc Surg 1980; 28: 446-448
  12. Baweja G, Nanda NC, Nekkanti R, Dod H, Ravi B, Fadel A. Three-dimensional transesophageal echocardiographic delineation of ventricular septal aneurysm producing right ventricular outflow obstruction in an adult. Echocardiography 2004; 21: 95-97.
  13. Ignaszewski AP, Collins-Nakai RL, Kasza LA, Gulamhussein SS, Penkoske PA, Taylor DA. Aneurysm of the membranous ventricular septum producing subpulmonic outflow tract obstruction. Can J Cardiol 1994; 10: 67-70.
  14. Hamby RI, Roberts GS, Meron JM, Davison ET, Herschman A. Isolated membranous septal aneurysm. N Y State J Med 1972; 72: 948-949.
  15. Kasparian H, Brest AM, Novack P. Congenital aneurysm of the membranous ventricular septum. Arch Intern Med 1965; 116: 753-758.
  16. Chesler E, Freiman I, Rosen E, Wilton E. Congenital aneurysm of the membranous ventricular septum associated with partial trisomy E syndrome. Am Heart J 1970; 79: 805-810.
  17. Saab NG, Smith RE, Ellis FH Jr. Unusual aneurysm of the membranous interventricular septum. Am Heart J 1966; 71: 684-689.
  18.  Restivo A, Smith A, Wilkinson JL, Anderson RH. Normal variations in the relationship of the tricuspid valve to the membranous septum in the human heart. Anat Rec 1990; 226: 258-263