PMC5371196_01
Four-chamber echocardiographic views of an apparent ventricular septal defect of the inferior septum (a) and an apparent pseudoaneurysm of the inferior wall (b), which persisted despite rotating the transducer 90 degrees or more from the four-chamber apical window. On repeat imaging, a very narrow apical window was identified in which the two-chamber view was seen without the pseudoaneurysm (c). Also shown is a three-dimensional echocardiographic depiction of the serpiginous nature of the ventricular septal dissection (d). Surgical view of the infarcted area and partial ventricular septal defect (e). Surgical view of the septum covered by a Dacron patch (f).
CRIC2017-9680891.001.jpg
PMC5371196_01_CRIC2017-9680891.001.jpg
fig1
Transthoracic echocardiography revealed a large ventricular septal defect (VSD) in the mid-inferior septal wall (Figure 1(a), Video 1 in Supplementary Material available online at https://doi.org/10.1155/2017/9680891) as well as a pseudoaneurysm in the mid-inferior wall, which persisted despite rotating the transducer 90 degrees from the apical four-chamber view (Figure 1(b), Video 2). On repeat imaging, a very narrow apical two-chamber view window in which the inferior wall was intact without the pseudoaneurysm (Figure 1(c), Video 3) was identified with difficulty. It was felt that the patient had a serpiginous dissection of the infarcted inferior septum (Figure 1(d), Video 4), which took on the appearance of a pseudoaneurysm on echocardiography. The partial defect in the septum was surgically covered by a Dacron patch (Figures 1(e) and 1(f)) during surgery, which was performed within 24 hours of the diagnostic echocardiogram.