Author + information
- Received November 12, 2014
- Accepted November 22, 2014
- Published online April 27, 2015.
- ∗Department of Cardiology, Green Lane Cardiovascular Service, Auckland, New Zealand
- †Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
- ↵∗Reprint requests and correspondence:
Dr. Jonathon M. White, Department of Cardiology, Green Lane Cardiovascular Service, Auckland Hospital, 2 Park Road, Grafton, Auckland 1023, New Zealand.
An 81-year-old man presented with fever and weight loss 5 years after coronary artery bypass surgery and open repair of a ventricular septal defect (VSD) with a Dacron patch following an anterior myocardial infarction. He had remained under clinical and echocardiographic surveillance with moderate left ventricular (LV) systolic dysfunction and a stable VSD repair. He was febrile and multiple blood cultures grew Staphylococcus warneri. Transthoracic echocardiography showed a large LV apical pseudoaneurysm with a stable VSD repair and moderate LV impairment. Transesophageal echocardiography documented a large vegetation attached to the right ventricular side of the VSD patch. Computed tomography (CT) confirmed a 5 × 7 cm, thin-walled saccular apical aneurysm (Figure 1). He responded promptly to treatment for endocarditis with 2 weeks of intravenous vancomycin followed by oral clindamycin. Surgical debridement and aneurysm repair were considered an unacceptable risk, so, after 4 weeks of treatment, he underwent percutaneous closure of the apical aneurysm neck with a 16-mm Amplatzer muscular VSD occluder (Figure 2, Online Video 1). He continued lifelong clindamycin and remained well at 5-year follow-up (age 86 years) with a follow-up CT documenting continued stable appearances of the VSD occluder, contraction of the pseudoaneurysm, and no evidence of right ventricular vegetation (Figure 3). This case demonstrates the very good long-term result that can be achieved by percutaneous LV pseudoaneurysm closure of even very large defects in inoperable patients.
For supplemental videos and their legends, please see the online version of this article.
The authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received November 12, 2014.
- Accepted November 22, 2014.
- American College of Cardiology Foundation