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Cardiovascular Images

Subepicardial Aneurysm Evaluated by Multiplane 2D and Real-Time 3D Volumetric Transesophageal Echocardiography

Hyun Suk Yang, MD, PhD; Sairav B. Shah, MD; John P. Sweeney, MD; Bijoy K. Khandheria, MD and Krishnaswamy Chandrasekaran, MD

From the Division of Cardiovascular Diseases, Mayo Clinic, Phoenix, AZ.

Correspondence to Krishnaswamy Chandrasekaran, MD, Professor of Medicine, Mayo College of Medicine, Division of Cardiovascular Disease, Mayo Clinic, 5777 East Mayo Boulevard, Phoenix, AZ 85054. E-mail kchandra@mayo.edu

An extract of the first 250 words of the full text is provided, because this article has no abstract.

A 76-year-old man with a history of hypertension, dyslipidemia, and 90 pack-year smoking, presented to his primary care physician with complaints of worsening dyspnea. His ECG finding did not show any pathological Q-wave or ST-T abnormalities (Online Figure I). A 2D transthoracic echocardiogram revealed normal left ventricular (LV) systolic function with inferior and inferolateral wall motion abnormalities. A suspicious aneurysm was also noted (Figure 1). His adenosine stress nuclear perfusion images showed a moderate-sized area of ischemia or jeopardized myocardium involving the infero-lateral LV (Online Figure II). He underwent cardiac catheterization, which revealed an occluded right coronary artery and significant left-to-right collaterals (Figure 2). Left ventriculography revealed a hypokinetic basal inferior wall and an aneurysm (Figure 3, Movie I). A follow-up transesophageal echocardiogram was performed using an x7–2t transducer on an iE33 ultrasound machine (Philips, Andover, MA) capable of both multiplane 2D and real-time 3D, which demonstrated the aneurysm within an intact epicardium (Figure 4, Movie II). This was consistent with a subepicardial aneurysm. Although the transthoracic echocardiogram and LV ventriculogram demonstrated the abnormality, the features were not distinct enough to differentiate aneurysm subtypes. However, multiplane 2D tomographic sections and the real-time 3D volumetric imaging precisely demonstrated a subepicardial aneurysm.

View larger version (54K):   Figure 1. A transthoracic echocardiogram of both end-diastolic (left panel) and end-systolic (right panel) frame reveals a focal aneurysm (arrow) at basal inferior wall. LV, left ventricle; ANT, anterior wall of LV; interferon (INF) , inferior wall of LV.

 

View larger version (134K):   Figure 2. The . . . [Full Text of this Article]