A left atrial aneurysm is a very rare cardiac anomaly that usually develops in the left atrial appendage. It usually develops congenitally, and has a risk of life-threatening complications. Here, we report a case of a growing aneurysm of the left atrium that was incidentally found in a 42-yr-old woman. Eighteen years prior, an abnormal cardiomegaly was found on a chest radiography for a pre-operative study. The chest radiography at this time demonstrated a more prominent cardiomegaly than the previous radiography findings. The left atrial aneurysm was diagnosed by echocardiography and cardiac catheterization. Although asymptomatic, she underwent a successful surgical excision to allay the possibilities of rupture, arrhythmia, heart failure, or thromboembolism. The surgical findings demonstrated an 8 x 15 cm sized saccular aneurysm at the left atrial appendage, and the pathologic findings showed three myocardial layers. The patient has been asymptomatic during the 15 months of follow-up. In conclusion, a congenital left atrial aneurysm can grow with time, even in asymptomatic cases, and an aneurysmectomy is a curative treatment, which can eliminate the potential complications.
Adult ; Echocardiography ; Female ; Heart Aneurysm/congenital* ; Heart Aneurysm/pathology* ; Heart Aneurysm/surgery ; Heart Aneurysm/ultrasonography ; Heart Atria/pathology* ; Heart Atria/surgery ; Heart Atria/ultrasonography ; Human

A 55-year-old man with a palpable pulsatile mass and pain in his left thigh was presented to us. He had no history of trauma in his left leg, interventions, operation, or medical diseases, including cardiac valve disease, endocarditis, and systemic infection. The size of the aneurysm was 10 cm×7 cm with a mural thrombus in ultrasonography and multidetector computer tomography. There was no evidence of other aneurysms or occlusive lesions in the other arteries. The aneurysm was resected without a vascular reconstruction of the deep femoral artery. The patient’s symptom improved rapidly. The patient had an uneventful postoperative recovery without complications. We report a case of true deep femoral artery aneurysm, which was successfully treated with resection of an aneurysm without a vascular reconstruction.
Aneurysm* ; Arteries ; Atherosclerosis ; Endocarditis ; Femoral Artery* ; Heart Valves ; Humans ; Leg ; Middle Aged ; Thigh ; Thrombosis ; Ultrasonography

The vein of Galen aneurysm is a rare vascular malformation but it can be detected by using conventional ultrasonography and diagnosed by using power Doppler ultrasonography. The prognosis of the vein of Galen aneurysm depends on congestive heart failure caused by cerebral shunt. Embolization at proper times can provide good outcome. We report a case of spontaneous delivery at 41 weeks of gestation by a 35-year-old woman presenting with a fetal vein of Galen aneurysm is described. The vein of Galen aneurysm was prenatally diagnosed by power Doppler ultrasonography and treated postnatally by embolization. This case is a report of successful prenatal diagnosis and postnatal management of the vein of Galen aneurysm.
Adult ; Aneurysm ; Cerebral Veins ; Female ; Heart Failure ; Humans ; Pregnancy ; Prenatal Diagnosis ; Prognosis ; Ultrasonography, Doppler ; Vascular Malformations ; Vein of Galen Malformations ; Veins

Pulmonary artery aneurysms are extremely rate and are seldom diagnosed during life. In true aneurysms, dilatation tends to be confined to the main trunk of the artery and degenerative changes in the wall are found. In 1971, Williams et al reported the first successful excision and replacement of the main pulmonary artery, including the bifurcation, with a dacron graft. Since then there have been few cases of main pulmonary artery aneurysm treated surgically. However, aneurysm of the main pulmonary artery treated surgically was not reported in our country till now. Recently we have experienced a case of the mainpulmonary artery aneurysm in a 10 years old boy and it was confirmed by echocardiogram, ultrasonogram of the chest, computed tomogram of the chest, radioisotope heart scan, cardiac catheterization and cine-angiogram of main pulmonary artery, aorta & right ventricle etc and patent ductus arteriosus was noted at the indifferent site from aneurysmal sac. Thereafter he underwent surgical correction at our hospital with the aid of total cardiopulmonary by-pass.
Aneurysm* ; Aorta ; Arteries ; Cardiac Catheterization ; Cardiac Catheters ; Child ; Dilatation ; Ductus Arteriosus, Patent ; Heart ; Heart Ventricles ; Humans ; Male ; Polyethylene Terephthalates ; Pulmonary Artery ; Thorax ; Transplants ; Ultrasonography

OBJECTIVE: To explore the value of transthoracic echocardiography (TTE) in transcatheter closure of atrial septal aneurysm (ASA) combined with secoundum-type atrial septal defect (ASD). METHODS: Fourteen patients (3 males and 11 females) who had ASA combined with secoundum-type ASD were diagnosed by TTE or transesophageal echocardiography. The ASA projected to the right atrium in all patients. The width of basilar part was 13 approximately 24 (18.5+/-3.9) mm, and the vertical extent was 7 approximately 11(9.7+/-1.8) mm. Ten patients combined with single hole ASD and 4 patients with multiple hole ASD. Blood shifting from the left atrium to the right atrium was displayed in color Doppler in all patients. All patients were treated by transcatheter closure under the guiding of X fluoroscopy and TTE, and examined with TTE during the follow-up. RESULTS: Transcatheter closure was successfully performed by 14 occluders in all patients. No residual shunt was detected immediately by TTE after the procedure in all patients. During the 6 approximately 12 month follow-up, no residual shunt or occluder shifting was found, the dimensions of the heart became normal in 11 patients (79%) and were significantly decreased in 4. CONCLUSION Transcatheter closure is feasible in patients with ASA combined with secoundum-type ASD, and extra attention must be paid to the specialty. TTE is very important in case selection before transcatheter closure, and it may be used to monitor and guide the procedure during transcatheter closure.
Adult ; Atrial Septum ; Balloon Occlusion ; methods ; Cardiac Catheterization ; Echocardiography ; Female ; Heart Aneurysm ; complications ; therapy ; Heart Septal Defects, Atrial ; complications ; therapy ; Humans ; Male ; Middle Aged ; Ultrasonography, Interventional ; Young Adult

A 32-yr-old man developed progressive exertional dyspnea 4 yr after blunt chest trauma due to an automobile accident. Two-dimensional echocardiography and computed-tomographic coronary angiography demonstrated a large pseudoaneurysm of the left ventricle and severe tricuspid regurgitation. The patient underwent successful surgical exclusion of the pseudoaneurysm by endoaneurysmal patch closure and repair of the tricuspid valve regurgitation. To the best of our knowledge, this is the first case of these 2 different pathologies presenting late simultaneously after blunt chest trauma and successful surgical repairs in the published literature.
Accidents, Traffic ; Adult ; Aneurysm, False/*diagnosis/*pathology/surgery/ultrasonography ; Coronary Angiography ; Dyspnea/diagnosis ; Heart Ventricles/pathology/ultrasonography ; Humans ; Male ; *Thoracic Injuries/etiology ; Tomography, X-Ray Computed ; *Tricuspid Valve ; Tricuspid Valve Insufficiency/*diagnosis/*pathology/surgery/ultrasonography

Right ventricular (RV) pseudoaneurysm caused by trauma is very rare. We report a case of RV pseudoaneurysm which resolved without surgical treatment in a patient who survived a falling accident. Echocardiography failed to identify the pseudoaneurysm. Electrocardiography-gated CT showed a 17-mm-sized saccular pseusoaneurysm arsing from the RV outflow tract with a narrow neck. Follow-up CT after two months showed spontaneous obliteration of the lesion.
Accidental Falls ; Aneurysm, False/etiology/*radiography/ultrasonography ; Cardiac-Gated Imaging Techniques/methods ; Echocardiography/methods ; Female ; Follow-Up Studies ; Heart Aneurysm/etiology/*radiography/ultrasonography ; Heart Ventricles/injuries/radiography/ultrasonography ; Humans ; Middle Aged ; Multidetector Computed Tomography/*methods ; Remission, Spontaneous ; Thoracic Injuries/*complications ; Wounds, Nonpenetrating/*complications

BACKGROUND AND OBJECTIVES: Intracardiac pathology results in 15 - 20% of ischemic stroke, but transthoracic echocardiography (TTE) has a number of limitations because of suboptimal precordial windows or ultrasound interference with prosthetic materials. Transesophageal echocardiography (TEE) provides superior resolution of basal structures such as the left atrium, left atrial appendage, mitral valvular apparatus, atrial septum, and aorta. The purpose of this study was to describe the various TEE findings which were sources of cerebral emboli. MATERIALS AND METHOD: The study population was comprised of 122 patients (mean age:54.5, male 83, female 39) who were admitted to Severance Hospital because of ischemic stroke from 1991 to 1997. All patients underwent TEE with agitated saline contrast administration. Patients without a definitive cardiac source of embolism underwent Holtor monitoring, internal carotid and cerebral angiography, as well as transcranial Doppler. RESULTS: 1) The number of patients diagnosed as cardioembolic stroke was 55 (45.1%). Atrial fibrillation was noted in 31 patients of cardioembolic stroke and it was the most frequent finding. Among these patients, 16 did not have any other cardiac problem. 2) We were able to find the possible source of embolism in 49 (40.2%) patients with TEE. Among these patients, 12 did not have dysrhythmia or any known previous heart problem. We found spontaneous echo contrast in the left atrium and left atrial appendage in 33 cases. There were 8 patients who had intracardiac thrombus. Among these patients, 6 patients had thrombi in the left atrial appendage, 1 in left atrium and 1 in left ventricular apex. We found patent foramen ovale in 3 cases and atrial aneurysm in 1 case. We found atheromatous plaque and/or thrombi of the aorta in 16 cases, while there were 4 cases where lesions located in the ascending aorta and aortic arch and which were considered as the source of embolism. Small thrombi in the left atrial appendage and left atrium were only detectable with TEE. CONCLUSIONS: We described TEE findings in ischemic stroke patients. And we assert TEE is a useful diagnostic tool in detecting the source of cardioembolic stroke and it may be used as a primary diagnostic tool in patients who are being evaluated for ischemic stroke.
Aneurysm ; Aorta ; Aorta, Thoracic ; Atrial Appendage ; Atrial Fibrillation ; Atrial Septum ; Cerebral Angiography ; Dihydroergotamine ; Echocardiography ; Echocardiography, Transesophageal* ; Embolism ; Female ; Foramen Ovale, Patent ; Heart ; Heart Atria ; Humans ; Intracranial Embolism ; Male ; Pathology ; Stroke* ; Thrombosis ; Ultrasonography

OBJECTIVESTo explore applicable protocol for the positioning of ventricular septal defect (VSD) occluder and the selection of the device by retrospective analysis of transcatheter closure approach to the aneurysms of the perimembranous VSD.

METHODSThirty-five cases of perimembranous VSD with septal aneurysm (19 males and 16 females) from May, 2004 to May, 2005 were included, with a mean age of 5.3 y and mean weight of 17.6 kg. Their angiographic and ultrasound data, and interventional processes were analyzed. Seven segments of the aneurysms were assessed: the diameter of the defect on the left ventricle, the diameter of the defect on the right ventricle, the thickness of ventricular septum, the distance from the farthest end of the aneurysm to the defect, the diameter of the widest part of the aneurysm and the distance between the two farthest orifices on the aneurysm.

RESULTSSixteen cystiform aneurysms and nineteen tubiform ones were identified with left ventricular angiography. The diameters of the orifices of aneurysms and the diameters of the VSDs ranged from 1.5 mm to 4.1 mm and 2.7 mm to 11.9 mm, separately, with the mean of 2.9 mm and 4.3 mm. From the echocardiography, the distances of the rim of defect to the aortic valve ranged from 2.0 mm to 7.0 mm, with the mean of 4.3 mm. All the interventions were successfully done with symmetrical devices from 4 mm to 14 mm. The left disc of the device was positioned at the defect surface from the left ventricle in 29 cases, and was released at the left side of the orifice in 3 cases.

CONCLUSIONSThe positioning of the left disc is mostly determined by the condition for the correct formation of the right disc in the right ventricle after deploying. Generally the defect surface in the left ventricle is most ideal to release the left disc of the device. If the body of aneurysm was too long for the right disc to restore its configuration, the left disc should be released on the left side of the orifice. The selection of device size is determined by the placement of the left disc. When the left disc is to be released at the defect surface in the left ventricle, the device size should be equal to or 1 to 2 mm larger than the diameter of the defect on the left ventricle. When the left disc is to be deployed on the left side of an orifice, the device size should be equal to or 1 mm larger than the defect diameter on the left ventricle when there is a single orifice. In the case of multiple orifices, the minimal size of the device which can cover all the orifices should be selected.

Adolescent ; Cardiac Catheterization ; methods ; Cardiovascular Surgical Procedures ; methods ; Child ; Child, Preschool ; Heart Aneurysm ; diagnostic imaging ; etiology ; surgery ; Heart Septal Defects, Ventricular ; complications ; diagnostic imaging ; surgery ; Humans ; Male ; Prosthesis Implantation ; methods ; Retrospective Studies ; Treatment Outcome ; Ultrasonography, Interventional

A pregnant patient at 32 weeks gestation presented for cerebral aneurysm surgery. Int-ravenous lidocane, pancuronium was administrated with 4% lidocane spray to facilitate tracheal intubation. Anesthesia was induced with thiopental and maintained with oxygen-nitrous oxide-enflurane. Thalamonal was also used to reduce blood pressure after tracheal intubation. Monitoring included an arterial catheter for measuring blood pressure and arterial blood gas tension, an electrocardiogram, an esophageal temperature probe, end-tidal carbon-dioxide monitor and a Dopp1er ultrasound fetal heart monitor. Induced bypotension guided by fetal heat rate with high-dose enflurane and hyperventi-lation was employed to facilitate aneurysm coating. During coating of the aneurysm, mean arterial blood pressure was reduced to 67 mmHg and maintained for 10 minutes. Throughout the anesthesia, the fetal heart rate remained between 110 and 144 beats/min. Following completion of anesthesia, the patient emerged from anesthesia and about 5 hours postoperatively premature labor could be seen with an external tocodynamometer, that was relieved by intramuscular injection of pethidine, 50 mg, Postoperatively the patient was discharged from hospital with a rapid and uneventful recovery at fifteenth day of operation. The mother was readmitted for elective cesarean section at 38 weeks of pregnancy and spinal anesthesia was performed. A healthy 2.9kg infant was delivered and they were uneventfully discharged. We report successful management of anesthesia in a pregnant patient undergoing aneurysm surgery during enflorane-induced hypotension with appropriate maternal and fetal monitoring.
Anesthesia ; Anesthesia, Spinal ; Aneurysm ; Arterial Pressure ; Blood Pressure ; Catheters ; Cesarean Section ; Electrocardiography ; Enflurane ; Female ; Fetal Heart ; Fetal Monitoring ; Heart Rate, Fetal ; Hot Temperature ; Humans ; Hypotension ; Hypotension, Controlled* ; Infant ; Injections, Intramuscular ; Intracranial Aneurysm* ; Intubation ; Meperidine ; Mothers ; Obstetric Labor, Premature ; Pancuronium ; Pregnancy* ; Thiopental ; Ultrasonography