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(Circulation. 2001;104:497.)
© 2001 American Heart Association, Inc.

Images in Cardiovascular Medicine

Multirow Detector Computed Tomography Assessment of Intraseptal Dissection and Ventricular Pseudoaneurysm in Postinfarction Ventricular Septal Defect

Jean-François Paul, MD; Loïc Macé, MD; Christophe Caussin, MD; Abdelhamid Fsihi, MD; Xavier Berthaux, MD; Philippe Brenot, MD; Claude Angel, MD

From the Department of Radiology, Cardiovascular Surgery and Cardiology, Centre Chirugical Marie Lannelongue, Le Plessis-Robinson, France.

Correspondence to Jean-François Paul, MD, Service de Radiologie, Centre Chirugical Marie Lannelongue, 133 avenue de la résistance, 92350 Le Plessis-Robinson, France. E-mail pauljf@ccml.com

A 46-year-old man had an acute inferior myocardial infarction after physical exercise. There was no evidence of heart failure. The ECG showed a 3-mm ST-T segment elevation with Q waves in leads D2, D3, and VF and a 3-mm depression in leads V2 to V4. Immediate coronary angiography evidenced a tight stenosis with distal slow flow that was located in the right coronary artery. Percutaneous transluminal coronary angioplasty, with implantation of 2 stents, was successfully performed. A normal flow was restored. Post-procedure ECG showed an isoelectric ST-T segment in leads D2, D3, and VF. Maximal creatine kinase elevation was 500 IU at 12 hours after the onset of clinical symptoms. Subsequent cardiac auscultation uncovered a loud holosystolic murmur. Color-coded Doppler echocardiography demonstrated a ventricular septal defect with a left to right shunt.

A multirow-detector computed tomography (CT, Volume Zoom, Siemens) scan procedure was performed with 4 iodine-enhanced, ECG-triggered, 1-mm slice acquisitions. Rotation time was 500 ms, accounting for a total breath-hold of 37 seconds. Diastolic gated and 3D reconstructions were performed at 70% RR intervals, with 0.6 mm increments of reconstruction. Three-dimensional reconstructions with vol-ume rendering showed both complex posterior ventricular septal rupture (Figure 1) and contiguous unsuspected pseudoaneurysm of the posteroinferior wall of the left ventricle (Figure 2).

View larger version (86K): [in this window] [in a new window]   Figure 1. Coronal view in the plane of the pulmonary artery with 3D rendering technique showing a ventricular septal defect (arrow) that was responsible for a right-to-left shunt, which was found on Doppler ultrasonography. PA indicates pulmonary . . . [Full Text of this Article]

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