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• W2158202637 abstract "HomeCirculationVol. 102, No. 17Severe Mitral Regurgitation After Valve Replacement as Cause of Pulmonary Venous Aneurysm Free AccessOtherPDF/EPUBAboutView PDFView EPUBSections ToolsAdd to favoritesDownload citationsTrack citationsPermissions ShareShare onFacebookTwitterLinked InMendeleyRedditDiggEmail Jump toFree AccessOtherPDF/EPUBSevere Mitral Regurgitation After Valve Replacement as Cause of Pulmonary Venous Aneurysm Steffen P. Christow and Rainer Dietz Steffen P. ChristowSteffen P. Christow From the Franz Volhard Clinic and Max-Delbrück Center for Molecular Medicine, Charité, Campus Berlin-Buch, Humboldt University of Berlin, Berlin, Germany. Search for more papers by this author and Rainer DietzRainer Dietz From the Franz Volhard Clinic and Max-Delbrück Center for Molecular Medicine, Charité, Campus Berlin-Buch, Humboldt University of Berlin, Berlin, Germany. Search for more papers by this author Originally published24 Oct 2000https://doi.org/10.1161/01.CIR.102.17.2159Circulation. 2000;102:2159–2160A4 9-year-old man was referred because of an acute myocardial infarction. He had undergone aortic and mitral valve replacements for endocarditis in 1984 (Figure 1). In the early 1990s, the mitral valve had developed a paravalvular leak that was not regarded as consequential. A right-sided mass was noted on the chest roentgenogram, however, that was interpreted as a pericardial “cyst.” The patient denied trauma, vasculitis, syphilis, and chronic granulomatous diseases and had not been known to have a pericardial cyst previously. On admission, the chest roentgenogram demonstrated cardiomegaly and a well-circumscribed circular mass adjacent to the right cardiac border (Figure 2). Transthoracic echocardiography demonstrated an enlarged right pulmonary vein (Figure 3, arrows). Color Doppler studies revealed 2 paravalvular leaks flanking the mitral valve prosthesis; the larger septal jet extended into the right pulmonary vein. CT confirmed the presence of a true aneurysm involving the right inferior pulmonary vein (Figure 4, arrows).True aneurysms of the pulmonary vein are rare, and little is known about their pathogenesis.1 However, an association between such aneurysms and mitral regurgitation has been described.123 Our patient’s lesion developed subsequent to his valve replacement and paravalvular regurgitation. The pathogenesis is believed to involve the force vector of blood flow from the left ventricle to the left atrium, targeting the right inferior pulmonary vein. This notion is supported by the higher wedge pressure V wave (48 versus 34 mm Hg, respectively) we observed when catheterizing the patient’s right compared with his left pulmonary vein. The same mechanism is held responsible for the right upper lobe pulmonary edema occasionally observed accompanying mitral regurgitation.4The editor of Images in Cardiovascular Medicine is Hugh A. McAllister, Jr, MD, Chief, Department of Pathology, St Luke’s Episcopal Hospital and Texas Heart Institute, and Clinical Professor of Pathology, University of Texas Medical School and Baylor College of Medicine.Circulation encourages readers to submit cardiovascular images to the Circulation Editorial Office, St Luke’s Episcopal Hospital/Texas Heart Institute, 6720 Bertner Ave, MC1-267, Houston, TX 77030.Download figureDownload PowerPoint Figure 1. Chest roentgenogram 2 years after double valve replacement showing normal right cardiac border.Download figureDownload PowerPoint Figure 2. Chest roentgenograms on admission showing cardiomegaly and circular lesion adjacent to right cardiac border (arrows). On lateral view, mass is located above right diaphragm at midmediastinal level.Download figureDownload PowerPoint Figure 3. Transthoracic echocardiogram showing enlarged right pulmonary vein (arrows). Color Doppler revealed 2 jets; larger septal jet extends into pulmonary vein.Download figureDownload PowerPoint Figure 4. CT showing true aneurysm involving right inferior pulmonary vein. LA indicates left atrium.FootnotesCorrespondence to Steffen P. Christow, MD, Franz Volhard Clinic, Charité, Campus Berlin-Buch, Wiltbergstraße 50, 13125 Berlin, Germany. E-mail [email protected] References 1 Sirivella S, Gielchinsky I. Pulmonary venous aneurysm presenting as a mediastinal mass in ischemic cardiomyopathy. Ann Thorac Surg.1999; 68:241–243.CrossrefMedlineGoogle Scholar2 Gabriele OF, Hood WP. Aneurysm of left atrium. Radiology.1970; 97:397–398.CrossrefMedlineGoogle Scholar3 Shida T, Ohashi H, Nakamura K, et al. Pulmonary varices associated with mitral valve disease: a case report and survey of the literature. Ann Thorac Surg.1982; 34:452–456.CrossrefMedlineGoogle Scholar4 Gurney JW, Goodman LR. Pulmonary edema localized in the right upper lobe accompanying mitral regurgitation. Radiology.1989; 171:397–399.CrossrefMedlineGoogle Scholar Previous Back to top Next FiguresReferencesRelatedDetails October 24, 2000Vol 102, Issue 17Article InformationMetrics Copyright © 2000 by American Heart Associationhttps://doi.org/10.1161/01.CIR.102.17.2159 Originally publishedOctober 24, 2000 PDF download Advertisement" @default.
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• W2158202637 title "Severe Mitral Regurgitation After Valve Replacement as Cause of Pulmonary Venous Aneurysm" @default.
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