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Send us your LVOT pseudoaneurysms!
Pseudoaneurysms of the left ventricular outflow tract are rare but potentially very serious complication of aortic valve replacement, composite aortic root replacement, and infective endocarditis. Because of relative rarity of this condition, very little is known of the natural history of these and treatment guidelines are empirical. The exception would be the pseudoaneurysm due to infective endocarditis, when the treatment guidelines are based on the infective endocarditis itself.
Felix Rogers, D.O., is requesting that members of the Michigan Society of Echocardiography pool their information about these left ventricular outflow tract pseudoaneurysms. The MSE can establish a registry which may allow us to compile a sufficient database to learn more about the frequency, natural history, and treatment recommendations for this condition.
Pseudoaneurysms that follow aortic valve replacement typically occur in the potential space between the aortic valve and the base of the anterior mitral leaflet. Over the years, this has variously been called the mitral-aortic intervalvular fibrosa, pseudoaneurysm of the intervalvular annulus fibrosa or LVOT pseudoaneurysms. These are best detected by CT angiography. The attached figure shows an example of a pseudoaneurysm of the mitral-aortic intervalvular fibrosa taken from a case report by Tahir Tak, M.D., Ph.D. published in Clinical Medicine and Research, 2003; 1(1): 49-52.
If you are able to submit one or more cases to our registry, it would be helpful if you could send a CD of the echocardiogram and where available the CT angiogram as well. In addition, please complete the description of patient characteristic found on table I.
Submit all of this information to:
Felix J. Rogers, D.O.,
Downriver Cardiology Consultants
5400 Fort St., Suite 200
Trenton, Michigan 48183.
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| LVOT Pseudoaneurysm |
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TABLE 1: Characteristics of patients with LVOT pseudoaneurysm after prosthetic aortic valve replacement.
Age, year
Sex
Indication for valve replacement
Surgical procedure
Suture technique (horizontal mattress, sutures with pledgets, etc.)
Transthoracic echocardiography (dated)
Transesophageal echocardiography (date)
MDCT (date)
Patient symptoms
Time of aortic valve replacement
Location of pseudoaneurysm in LVOT (noncoronary, left coronary)
Thrombosis (none, partial, total)
Neck diameter in mm
Size of pseudoaneurysm in mm3
Treatment
Current condition
Length of follow up after demonstration of pseudoaneurysm
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