J Cardiovasc Ultrasound.  2015 Dec;23(4):276-279. 10.4250/jcu.2015.23.4.276.

Huge Multilobulated Left Ventricular Outflow Tract Pseudoaneurysm Presenting with Ventricular Tachycardia

• Kharwar RB
• Shukla A

• KMID: 2144462
• DOI: http://doi.org/10.4250/jcu.2015.23.4.276

Abstract

No abstract available.

Keyword

Ventricular tachycardia; Pseudoaneurysm; Left ventricular outflow tract

MeSH Terms

Aneurysm, False*
Tachycardia, Ventricular*

Figure

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  Fig. 1 The presenting electrocardiogram of the patient showing monomorphic ventricular tachycardia originating from the left ventricular outflow tract region (A). Post direct current cardioversion, patient regained normal sinus rhythm but with bifascicular block in the form of right bundle branch block with left anterior hemiblock (B). aVR: augmented vector right, aVL: augmented vector left, aVF: augmented vector foot.

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  Fig. 2 Chest X-ray showing cardiomegaly with a bulge at the upper left cardiac border along with multiple calcified round to oval shadows (white arrows) within the cardiac silhouette.

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  Fig. 3 Transesophageal echocardiography with color Doppler. The mid esophageal four chamber view showing a large calcified mass in the basal septal region compressing the LV cavity (A) leading to mild mitral regurgitation (B). The aortic valve was tri-leaflet as seen in the basal short axis view (C) and there was moderate aortic valve regurgitation in the LV out flow view (D). Ao: aorta, LA: left atrium, LV: left ventricle, LVOT: left ventricular outflow tract, PA: pseudoaneurysm, RA: right atrium, RV: right ventricle.

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  Fig. 4 Multidetector computed tomography. The communication of the pseudoaneurysm with the LVOT can be clearly seen in the axial section (A). The multilobulated nature, the calcified rims and the thrombosed lumen of the pseudoaneurysm can also be seen in the axial section (B), coronal section (C) and the sagittal section (D). Ao: aorta, LA: left atrium, LV: left ventricle, LVOT: left ventricular outflow tract, PA: pseudoaneurysm.

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  Fig. 5 Invasive left ventriculography in the right anterior oblique projection (A) and in the left anterior oblique (LAO) projection with cranial angulation (B) showing the calcified, multilobulated LVOT pseudoaneurysm filling partially due to the thrombosed internal lumen. Invasive coronary angiogram in the straight anteroposterior projection (C) and in the LAO projection with caudal angulation (D) showing the extrinsic compression of the proximal LAD coronary artery by the pseudoaneurysm. Ao: aorta, LAD: left anterior descending, LV: left ventricle, LVOT: left ventricular outflow tract.

Reference

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