Complete Postsurgical Left Ventricular-Aortic Discontinuity and
Pseudoaneurysm Formation
Abstract
Background: Left ventricular outflow tract pseudoaneurysm is a rare but
potentially fatal complication of aortic valve replacement, infective
endocarditis, and suture dehiscence. Left ventricular-aortic
discontinuity is a severe and uncommon manifestation of IE. For patients
who have a long-standing history of endocarditis, peri-annular lesions
in the aortic valve may rupture, leading to the rare occurrence of
complete, or total, left ventricular-aortic discontinuity. Methods: We
present a case of complete postoperative left ventricular-aortic
discontinuity and massive circumferential left ventricular outflow tract
pseudoaneurysm discovered during a 3-month follow-up visit. Results:
Post-operative cardiac CT of a patient demonstrated dehiscence of a
recently placed surgical aortic valve from the left ventricular outflow
tract, with massive circumferential pseudoaneurysm formation. Only a
small remnant of the membranous interventricular septum connected the
aortic root to the heart, informing the diagnosis of complete left
ventricular-aortic discontinuity. Conclusion: The clinical presentation
of a left ventricular outflow tract pseudoaneurysm with concomitant left
ventricular-aortic discontinuity is commonly nonspecific or clinically
silent; thus, it requires a high index of suspicion and use of
multimodality imaging for diagnosis and management.