J Cardiovasc Ultrasound.  2010 Dec;18(4):157-160. 10.4250/jcu.2010.18.4.157.

A Case of Left Ventricular Pseudoaneurysm in the Left Atrioventricular Groove after Mitral Valve Replacement

• Jung HS
• Chung WB
• Yang KS
• Yang HK
• Gweon TG
• Lee GJ
• Hong JH
• Jung JI
• Song H
• Youn HJ

• KMID: 2177320
• DOI: http://doi.org/10.4250/jcu.2010.18.4.157

Abstract

Left ventricle-coronary sinus fistula and left ventricular pseudoaneurysm are unusual and frightening complications after mitral valve replacement. A 27-year-old female patient underwent mitral valve replacement 5 years previously and trans-thoracic echocardiography showed an outpouching lesion at the atrioventricular groove. It was difficult to differentiate whether the lesion was a left ventricle-coronary sinus fistula or a left ventricular pseudoaneurysm by two-dimensional echocardiography. Cardiac computed tomography confirmed a left ventricular pseudoaneurysm compressing the coronary sinus.

Keyword

Pseudoaneurysm; Coronary sinus fistula; Mitral valve replacement

MeSH Terms

Adult
Aneurysm, False
Coronary Sinus
Echocardiography
Female
Fistula
Humans
Mitral Valve

Figure

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  Fig. 1 Apical two chamber view shows a pseudoaneurysm at the postero-inferior wall of the left ventricle with a narrow communication mouth (arrow) (A). The apical two chamber view of color Doppler imaging in the diastolic phase demonstrates blood circulation between the left ventricle and the pseudoaneurysm through a narrow mouth (arrow) (B). The parasternal short axis view (C) and color Doppler imaging (D) at the mitral valve level also show the anatomical relations of the pseudoaneurysm. LV: left ventricle, PsA: pseudoaneurysm.

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  Fig. 2 The coronal plane (A) and short axis plane (B) of cardiac CT show the outpouching pseudoaneurysm arising from the postero-inferior wall of the left ventricle, just beneath the replaced prosthetic mitral valve. Cardiac CT shows the aneurysmal sac at the AV-groove without a discernible wall, and this was considered to be a pseudoaneurysm. The pseudoaneurysm compressed the opening of the coronary sinus, resulting in dilatation of the coronary sinus (arrow)(C). The three-dimensional reconstruction image of cardiac CT shows the pseudoaneurysm and dilated coronary sinus (arrow)(D).

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