Year : 2008  |  Volume : 1  |  Issue : 2  |  Page : 142--143

Ruptured submitral aneurysm in an eight-year-old girl


Anil Kumar Singhi, Edwin Francis, Raman Krishna Kumar 
 Department of Pediatric Cardiology, Amrita Institute of Medical Sciences, Kochi, India

Correspondence Address:
Raman Krishna Kumar
Chief Pediatric Cardiologist, Amrita Institute of Medical Sciences, Elamakkara PO, Kochi
India

Abstract

We present illustrative images of submitral aneurysm in a young girl. The diagnosis was established on echocardiography and the extent of the problem was defined through multi-detector computerized tomography.



How to cite this article:
Singhi AK, Francis E, Kumar RK. Ruptured submitral aneurysm in an eight-year-old girl.Ann Pediatr Card 2008;1:142-143


How to cite this URL:
Singhi AK, Francis E, Kumar RK. Ruptured submitral aneurysm in an eight-year-old girl. Ann Pediatr Card [serial online] 2008 [cited 2022 Aug 16 ];1:142-143
Available from: https://www.annalspc.com/text.asp?2008/1/2/142/43882


Full Text

 Introduction



Submitral aneurysm is a well-recognized condition of varying etiology. It is uncommon in children. It is seen as congenital anomaly, rarely presenting as complication of infective endocarditis. [1],[2]

 Clinical Summary



An eight-year-old girl was admitted to our institution with a history of rapidly progressing respiratory distress and heart failure since three days. Her condition worsened soon after admission and she required mechanical ventilation. Her white cell count was elevated (28,000/mm 3 ) and three blood cultures were positive for Klebsiella Pneumoniae. Echocardiography [Figure 1] showed a large submitral aneurysm adjacent to the lateral papillary muscle of the mitral valve tensor apparatus. It extended posteriorly and to the left of the left ventricle. The aneurysm ruptured back into the left atrium [Figure 1] and [Figure 2]. The posterior mitral leaflet was relatively immobile. A multi-detector CT scan [Figure 2] showed the extent of the aneurysm and its relationship to neighboring thoracic structures. The aneurysm distorted the mitral valve apparatus resulting in severe mitral regurgitation [Figure 3]. The child was stabilized over next few days and was operated after two weeks of antibiotics guided by the sensitivity reports. The mouth of the aneurysm was closed from within the left ventricle using a tanned autologous pericardial patch and the mitral valve was replaced using an antibiotic impregnated metallic prosthetic valve. The postoperative recovery was uneventful.

 Discussion



These images are being presented to illustrate the anatomy of submitral aneurysm. Rupture of the aneurysm into the left atrium has been described and may have been responsible for the sudden worsening of the child's condition. The precise definition of all details that is necessary for planning of surgical repair can often be obtained entirely through echocardiography. However, the relationship of the aneurysm to neighboring thoracic structures requires either MRI or CT scan.

References

1Kontozis L, Skoularigis J, Skudicky D, Sareli P. Submitral aneurysm. Circulation 1998;98:1698.
2Guimarγes AC, Filho AS, Esteves JP, Waldeck NA, Vinhaes L A, Jose A, et al. Annular subvalvular left ventricular aneurysm in Bahia, Brazil. Br Heart J 1976;38:1080-5.