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.
Denault AY, Chaput M, Couture P, et al. Dynamic right ventricular outflow tract obstruction in cardiac surgery. J Thorac Cardiovasc Surg. 2006;132:43–9.
Vidne BA, Subramanian S, Wagner HR. Aneurysm of the membranous ventricular septum in transposition of the great arteries. Circulation. 1976;53:157–61.
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.
Chen SY, Chan KL, Beauchesne LM. Right ventricular outflow tract obstruction secondary to a membranous ventricular septal aneurysm. Eur J Echocardiogr. 2011;12:886.
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.
This study was supported by the Serbian Ministry of Education, Science and Technological Development (III41007, ON174028)
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
About this article
Cite this article
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). https://doi.org/10.1007/s12471-018-1150-0