Document 396711

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Clinical vignette
Online publish-ahead-of-print 26 June 2007
Late pulmonary artery aneurysm combined with subpulmonary left ventricular outflow tract obstruction
in corrected transposition of the great arteries
Jan Dominik1, Karel Medilek1, Pavel Zacek1*, and Josef Stasek2
Department of Cardiac Surgery, Faculty of Medicine, Charles University Prague, University Hospital, Sokolska tr. 50,
Hradec Kralove 500 05, Czech Republic and 2Department of Internal Medicine, Faculty of Medicine, Charles University
Prague, University Hospital, Sokolska tr. 50, Hradec Kralove 500 05, Czech Republic
* Corresponding author. Tel: þ42 49 5832143; fax: þ42 49 511953. E-mail address: [email protected]
A 57-year-old male was admitted due to exertional dyspnoea and
fatigue, which are the first symptoms of congenitally corrected
transposition of the great arteries. Unusual combination of subpulmonary obstruction caused by membranous ventricular septal
aneurysm and a large pulmonary artery aneurysm was diagnosed
by cineangiography (Panel A) and echocardiography (Panel B, D).
The defects (Panel C) were successfully corrected by reduction
pulmonary arterioplasty and interventricular septal aneurysm
repair. Post-operative course was uneventful and the patient is
free of symptoms at 3 months of follow-up.
Panel A. Right ventriculography in left anterior oblique view:
aneurysm of the membranous interventricular septum bulging into
the subpulmonary left ventricular outflow tract.
Panel B. Transthoracic echocardiography, four-chamber view in
zoom: interventricular septum (IVS), aneurysm of membranous IVS
(asterisk) causing outflow tract obstruction (arrow), right atrium
(RA), and pulmonary valve (PV).
Panel C. Median sternotomy: typical transpositional morphology
of the great arteries with a large pulmonary artery aneurysm
(8 cm in diameter). Pulmonary artery (PA), aorta (Ao), and right atrium (RA).
Panel D. Transthoracic echocardiography, modified short-axis view: pulmonary artery aneurysm.
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