Posterior pseudoaneurysm of the left ventricle: a prospective echocardiographic diagnosis.

A 69-year-old man had a posterior pseudoaneurysm of the left ventricle shown by echocardiography and cardiac catheterization. The patient had resection of the pseudoaneurysm and did well. The case illustrates the usefulness of echocardiography for detecting and evaluating left ventricular pseudoaneurysm and the effectiveness of surgery for that entity.     

Subepicardial aneurysm of the left ventricle

Three patients are presented in whom a subepicardial aneurysm developed as a complication of a myocardial infarction. This aneurysm of the left ventricle is unusual and has 3 distinctive traits: an abrupt interruption of the myocardium that comprises the mouth and typically a narrow neck of the aneurysm; aneurysmal wall comprised of epicardium with or without a thin myocardial layer; and a propensity to rupture spontaneously regardless of the wall components or stage of development. All 3 patients were given a diagnosis using echocardiography and underwent immediate surgical aneurysmectomy. One patient died as a result of renal and respiratory failure postoperatively. The long-term outcome of the other 2 patients was favorable without evidence of additional cardiac rupture or instability.     

Two-dimensional echocardiographic diagnosis of double outlet left ventricle with subaortic ventricular septal defect, pulmonary stenosis, and a hypoplastic left ventricle.

Double outlet left ventricle (DOLV) is a rare congenital cardiac malformation in which both the pulmonary artery and the aorta arise exclusively or predominantly from the morphologic left ventricle. We describe a case of DOLV with situs solitus, d-loop ventricles, d-malposition of the great arteries (S, D, D), severe pulmonary stenosis, and a subaortic ventricular septal defect in which the left ventricle was also severely hypoplastic. The anatomic features were shown with 2-dimensional echocardiography, and the diagnosis was later confirmed at cardiac catheterization. Many morphologic variations of this malformation have been described but to the our knowledge DOLV with a hypoplastic left ventricle has not been reported before.     

Two-dimensional echocardiographic features of double outlet left ventricle

In a cyanotic newborn infant, the diagnosis of double outlet left ventricle was made from the two-dimensional echocardiographic examination. The diagnosis was later confirmed at cardiac catheterization and surgery. The parasternal and subcostal views were especially useful for identification of the origin of both great arteries from the morphologic left ventricle. A review of the medical literature since 1967 revealed 77 cases of double outlet left ventricle, most of which were diagnosed only at surgery or postmortem examination. The anatomic features demonstrated with two-dimensional echocardiography in this case are representative of the findings cited most often in the cases reported in the medical literature.     

Descent of the base of the left ventricle: an echocardiographic index of left ventricular function

Mitral annular apical systolic excursion or descent of the base (DB) of the left ventricle has been qualitatively observed by two-dimensional echocardiography studies to decrease as left ventricular systolic function deteriorates. On the basis of this observation a quantitative assessment of DB was examined as a means to estimate left ventricular ejection fraction (LVEF). Two-dimensional echocardiographic apical images were obtained in 100 subjects, 26 normal individuals and 74 clinical patients. Major diagnoses in the clinical patients were dilated cardiomyopathy in 24, coronary artery disease in 13, valvular disease in 16, left ventricular hypertrophy in 8, and no evident heart disease in 12. Wall motion was visually assessed; 22 subjects had a segmental wall motion abnormality, and 21 had a diffuse wall motion abnormality. All patients had a complete Doppler examination, and 31 had mitral and/or aortic regurgitation judged to be 2+ (moderate) or greater in severity. To quantitate DB the difference of the distance from the apex of the sector fan to the middle-mitral annular plane between end-diastole and end-systole in both two- and four-chamber views was calculated. Left ventricular end-diastolic volume and LVEF were calculated with a modified Simpson's rule algorithm applied to planimetered apical two- and four-chamber images. The mean DB of the normal subjects was 12 +/- 2 mm with both two- and four-chamber images. All normal subjects had a DB of 8 mm or greater. LVEF in percentage was linearly related to DB (millimeters) as follows. Two-chamber view, LVEF = 3.8 DB + 21; r = 0.78; standard error of the estimate = 14% Four-chamber view, LVEF = 4.1 DB + 17; r = 0.84; standard error of the estimate = 12% A four-chamber DB of less than 8 mm was associated with a depressed LVEF (less than 50%) with 82% specificity and 98% sensitivity. DB for a given LVEF was slightly increased in patients with 2+ or greater mitral and/or aortic regurgitation (p less than 0.001). Similarly, DB for a given LVEF in patients with a diffuse wall motion abnormality was slightly increased compared with those patients with a segmental wall motion abnormality (p less than 0.001). Comparison of left ventricular end-diastolic volume to DB showed a poor linear correlation. In conclusion, DB quantitation provides a useful, noninvasive method to estimate LVEF.     

Giant congenital aneurysm of the right atrium: echocardiographic diagnosis and surgical management.

A rare case of giant congenital aneurysm of the right atrium in a 30-year-old woman is described. The patient had no history of cardiac diseases or trauma. Transthoracic 2-dimensional echocardiography with injection of isotonic saline enabled complete definition of the abnormal anatomy and allowed subsequent successful surgical correction.     

Giant left atrial appendage aneurysm: The third ventricle!

The giant congenital intrapericardial aneurysmal dilatation of the left atrial appendage without mitral valve disease is a very rare condition that is generally diagnosed in older patients. The problem is usually accompanied with supraventricular rhythm disorders and life-threatening systemic thromboembolism. Complete surgical correction is possible, and it should be performed immediately after the diagnosis. We are going to describe a patient with a history of cerebral thromboembolism and palpitation who was diagnosed with congenital intrapericardial aneurysmal dilatation of the left atrial appendage. The condition was identified by means of echocardiography and was surgically treated by resection of the appendage containing the aneurysm.This case report was presented in the DICE session of The Turkish Society of Echocardiography at 6th European Congress of Echocardiography (EUROECHO 6) which was held in Munich, Germany (December 4–7, 2002).     

Traumatic aneurysm and pseudoaneurysm of the right ventricle: a diagnosis by echocardiography.

We report a case of a rare aneurysm of the right ventricular outflow tract, and a pseudoaneurysm of the right ventricle caused by a remote motor vehicle accident.     

Improved two-dimensional echocardiographic technique for left ventricular aneurysm detection

In order to determine the sensitivity and reproducibility of a new two-dimensional echocardiographic technique for detecting left ventricular aneurysms, 16 patients suspected of having aneurysms were evaluated prospectively. Left ventricular angiography demonstrated aneurysms in 15 of the 16 patients. All 15 were detected by two-dimensional echocardiography but three were identified only in a view rotated 45 degrees clockwise from the apical four-chamber view. The analysis of 16 wall segments for each patient showed excellent agreement between two observers. Therefore, two-dimensional echocardiography, utilizing four apical views 45 degrees apart, is reliable and reproducible for the detection of left ventricular aneurysms.     

超声诊断左室多发性憩室1例

图１胸骨旁左室长轴切面,箭头所示为憩室。图２胸骨旁左室乳头肌水平短轴切面,箭头所示为憩室。图３心尖四腔切面,箭头所示为憩室。病例男,２５岁,因反复心悸、胸闷５年来诊。否认近期有心绞痛及胸部外伤史,当地超声检查疑左室室壁瘤。查体：双肺无罗音,心脏大小正常,心率８４次／分,律不整,可闻及早搏,各瓣膜区未闻及病理性杂音。Ｘ线胸片检查心肺无异常。心电图提示频发室性早搏,心肌未见缺血。超声心动图所见：心脏各房室不大,瓣膜形态及开放、关闭正常,心功能ＥＦ６４％,各瓣膜口无返流。胸骨旁左旁长轴切面图１、胸骨旁…