Aneurysmal dilatation of pericardial patch closure of VSD
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Perimembranous ventricular septal defect (VSD) is a commonly encountered congenital heart defect. Surgical patch repair of large VSDs is the preferred surgical therapy. The present case has been reported in the European Heart Journal - Case Reports.

A 68-year-old woman with past medical history of hypertension, hyperlipidaemia, and obstructive sleep apnoea, underwent VSD repair with an autologous pericardial patch at 6 years of age, in 1958. Patient was referred in 2016 by her primary care physician. Since the surgical VSD repair as a child, she had done well and had not had any further surgical evaluations. S

Transthoracic echocardiogram was concerning for aneurysmal dilatation originating below the level of aortic root and a sub-aortic membrane, normal biventricular size, and function with left ventricle ejection fraction 60–65%.

The Doppler gradients across the right ventricular outflow tract and the sub-aortic membrane were not clinically significant. Cardiac CT scan was obtained to further evaluate the aneurysm. Oblique multiplanar reconstructions of the CT images allowed for accurate sizing and showed an aneurysmal calcified pericardial patch with protrusion into the right ventricular outflow tract.

Based on the imaging findings, absence of clinically significant right ventricular outflow tract or sub-aortic obstruction, and patient’s lack of symptoms; multidisciplinary heart team and the patient decided on conservative management with yearly clinical and echocardiographic follow ups. On her subsequent visits, the patient continued to do well and the aneurysm remained unchanged.

Key takeaways:-
- Pericardial patch-defect size mismatch and large sized patches are the major risk factors for developing a pericardial patch aneurysm.

- Age of presentation and lack of symptoms, makes this case unique and different from those reported previously.

- This case also highlights that multiplanar reconstruction of cardiac CT images allows for sizing, identifying remodelling and detecting complications.

- Once identified on CT, serial follow-up of the aneurysm can be done yearly with echocardiography to avoid radiation.

- Pericardial patch aneurysms are relatively stable and surgery is rarely indicated unless the aneurysm causes mechanical compression or obstruction of the right ventricular outflow.