PMC5803987_01
Prenatal US at 33 weeks' gestational age with red arrow showing dilation of the left ventricle directly under the mitral valve. Given echocardiogram and magnetic resonance imaging in the 1st week of life, this was likely aneurysmal dilation. The left atrial aneurysm is not visualized here or during prenatal US
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F1
Fetal ultrasound revealed enlarged heart with small periventricular effusion [Figure 1].
Echocardiogram imaging: (a) Four chamber view, day 1 of life, showing large left ventricle submitral free wall aneurysm. (b) Parasternal short axis view, day 7 of life, showing left atrial aneurysm with hyperechoic mass at apex (arrow), presumed to be a blood clot
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F2
He was placed on enoxaparin sodium (Brand name - Lovenox, Manufacturer - Sanofi-aventis) and was transferred to a quaternary facility [Figure 2].
(a) Sagittal plane T2 cardiac magnetic resonance imaging, day 7 of life, showing left atrial appendage aneurysm and hypoechoic blood clot at the ventral aspect. The left ventricular free wall aneurysm can be seen directly below left atrial. (b) Sagittal oblique cardiac magnetic resonance imaging with free wall left ventricular aneurysm with free communication to the left ventricle
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F3
Surgical LA aneurysm resection was performed, but the clot had already embolized to the left iliac bifurcation without evidence of limb ischemia [Figure 3].
Postoperative apical view echocardiogram with and without Doppler flow showing the development of new left ventricular apical pseudoaneurysm. Arrow shows apical pseudoaneurysm and color flow study shows flow into the pseudoaneurysm during cardiac systole
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F4
Postoperative echocardiogram revealed the development of a left ventricle apex pseudoaneurysm which required surgical plication [Figure 4].
Apical 4 chamber view echocardiogram performed at 6 years of age showing persistent large submitral left ventricular aneurysm marked by red arrow
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F5
Serial echocardiograms continue to show large aneurysm of the left ventricle free wall with good LV function [Figure 5].