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|Year : 1979 | Volume
| Issue : 4 | Page : 245-246
Aneurysm of membranous interventricular septum
Lilam S Shah, DR Kulkarni, AS Vengsarkar
Department of Cardiology,K.E.M Hospital,Parel,Bombay 400012., India
Lilam S Shah
Department of Cardiology,K.E.M Hospital,Parel,Bombay 400012.
Source of Support: None, Conflict of Interest: None
Echocardiographic features of an aneurysm of membranous interventricular septum are presented in a case of coarctation of aorta with membranous interventricular septal defect. The diagnosis was made by angiography.
|How to cite this article:|
Shah LS, Kulkarni D R, Vengsarkar A S. Aneurysm of membranous interventricular septum. J Postgrad Med 1979;25:245-6
| :: Introduction|| |
Formation of aneurysm in membranous interventricular septum has been reported. ,,,, Aneurysm of membranous septum is one of the mechanisms accounted for the spontaneous closure of the ventricular septal defect. Echocardiographic recognition of the aneurysm of membranous interventricular septum is reported in this case.
| :: Case report|| |
Rajesh Prasad, a 7 year old child presented with symptoms suggestive of respiratory tract infection. He was found to have a murmur since early childhood. Clinical examination revealed a pulse of 80/min., regular, with brisk upstroke. B.P. in upper limbs was 180/110 ram Hg. In the lower limbs, systolic B.P. was 110 mm Hg. whereas diastolic B.P. was not recordable. There was radiofemoral delay; there was no clubbing, or cyanosis and also no evidence of cardiac failure. Cardiovascular system examination revealed mild right ventricular hypertrophy, pansystolic murmur gr. 3/6 along the left sternal edge in 3-4th left intercostal space, pulmonary ejection systolic murmur and moderate accentuation of pulmonic component of the second heart sound. X-ray chest showed cardiomegaly, left ventricular hypertrophy and moderate increase in pulmonary vascularity. ECG revealed left ventricular hypertrophy with strain pattern. Cardiac catheterization showed step up in SaO 2 % at ventricular level suggesting left to right shunt at the ventricular level (Qp/Qs = 1.5:1). Left ventricular angiography revealed opacification of ventricular outflow tract with an outpouching of the membranous septum (See [Figure 1A] on page 246A)There was post ductal coarctation of aorta (See [Figure 1B] en page 246A). Ductus arteriosus was absent and pulmonary artery was opacified through membranous ventricular septal defect.
The patient was subjected to echocardiographic studies. Echoes from the aneurysm of membranous septum were obtained from positions 2 and 3 (See [Figure 2] on page 246A). [Figure 3] (see on page 246A) shows echoes from the buldging of membranous septum in late systole. Systolic pressure difference between the two ventricles was responsible for the bulging of the aneurysm of membranous septum.
| :: Discussion|| |
The technique of detection of echoes from aneurysm of membranous interventricular septum is described by Sapire et al  The timing of the appearance of these echoes from aneurysmal sac in relation to cardiac cycle varies though usually these are more prominent during systole.  Similar findings are obtained in our case. [Figure 3] shows echoes from aneurysm of membranous interventricular septum more prominent in late systole. These echoes seem to be originating from the base (membranous) of the septum in systole and protruded in right ventricular out flow tract. Angiographic appearance of this aneurysmal bulge from membranous interventricular septum into the right ventricular out flow tract confirmed the origin of these echoes. It caused right ventricular out flow obstruction of a mild degree.
| :: References|| |
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|3.||Edelstein, J. and Charmes, B. L.: Ventricular septal aneurysms. A report of 2 cases. Circulation, 32: 981-984, 1965. |
|4.||Hamby, D. I., Raia, F. and Apaido, O.: Aneurysm of the pars membranacia. Report of three adult cases, and review of literature. Amer. Heart J., 79: 688-699, 1970. |
|5.||Pombo, E., Pilapil, V. R. and Lehan, P. H.: Aneurysm of the membranous ventricular septum. Amer. Heart J., 79: 188-193, 1970. |
|6.||Sapire, D. W. and Black, I. F. S.: Echocardiographic detection of aneurysms of the interventricular septum associated with the ventricular septal defect. Amer. J. Cardiol., 36: 797-801, 1975. |
|7.||Tandon, R. and Edward, J. E.: Aneurysm like formation in relation to membranous ventricular septum. Circulation, 47: 10891097, 1973 |
[Figure 1A], [Figure 1B], [Figure 2], [Figure 3]