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Seventeen Years Later A Rare Case of Submitral Ventricular Pseudoaneurysm After Cardiac Surgery

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by

Vishnu
in

Introduction

Cardiac surgeries often offer life-saving outcomes, yet rare complications can emerge even years later. One such uncommon yet critical condition is Submitral Ventricular Pseudoaneurysm (SLVP), which may arise long after mitral valve replacement. A recent case highlights the late manifestation of this condition in a 59-year-old woman, seventeen years post-surgery underlining the need for continued vigilance and advanced diagnostics.
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Case Summary: A Hidden Threat Revealed Years Later

  • Patient Profile: 59-year-old woman with a history of mechanical mitral and aortic valve replacement.
  • Symptoms: Persistent dyspnea and fatigue.
  • Initial Discovery: Transthoracic echocardiography revealed a suspicious echogenic mass near the mitral-aortic junction.
  • Diagnostic Imaging:
    • LVEF: 30%
    • LVEDV: 182 ml
    • sPAP: 42 mmHg
    • CT Scan: Giant 10×6 cm pseudoaneurysm at the posterior mitral valve annulus.

Key Insight: The pseudoaneurysm appeared nearly two decades after surgery, suggesting that even stable patients require long-term follow-up imaging.

Understanding the Condition and Surgical Implications

Submitral ventricular pseudoaneurysms are typically caused by:

  • Infective endocarditis
  • Post-operative structural alterations
  • Congenital weaknesses near the mitral annulus

Complications Include:

  • Fistula formation
  • Compression of coronary/pulmonary arteries
  • Potential rupture and embolization
  • Valve dysfunctions

A detailed analysis can be found in our main journal article.

The American Heart Association highlights the importance of lifelong cardiovascular imaging in patients with prosthetic valves to detect such latent anomalies early.

Treatment Strategy and Patient Outcome

Options Considered:

  • Surgical repair (preferred for aneurysms >3 cm or symptomatic cases)
  • Endovascular approach (less invasive, for select stable cases)
  • Observation (when risk outweighs benefit of intervention)

Despite a high EuroSCORE II and STS risk profile, surgery was advised. However, the patient declined operative management and remains under clinical observation, currently classified as NYHA class II.

A conservative approach was adopted given the absence of active infection and high operative risk.

Clinical Significance and Long-Term Care

This case reiterates the importance of:

  • Multimodal imaging (TTE, MDCT, MRI)
  • Long-term post-surgical monitoring
  • Tailored therapy based on anatomical and clinical risk stratification

According to the European Society of Cardiology, patients with structural heart alterations post-valve replacement should undergo periodic imaging for early detection of complications like SLVP.

Conclusion

The presented case is a striking example of how cardiac surgery, although successful, can carry long-term risks that manifest years later. Incorporating multimodal imaging and patient-centric risk assessments are vital in managing such rare complications effectively.

Visit https://www.anesthesiaresjournal.com/ to explore more compelling case studies and innovative research in anesthesiology and cardiovascular care.

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Disclaimer: This content is generated using AI assistance and should be reviewed for accuracy and compliance before considering this article and its contents as a reference. Any mishaps or grievances raised due to the reusing of this material will not be handled by the author of this article.

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