Browsing by Author "Du Toit, Henning"

Now showing 1 - 1 of 1
  • Thumbnail Image
    Item
    Open Access
    Left ventricular submitral aneurysms
    (2007) Du Toit, Henning; Hewitson, John; Lawrenson, John
    Retrospective institutional review of the pathology, aetiology classification and surgical management of left ventricular submitral aneurysms (LVSMA). These aneurysms are a well recognized but relatively rare disease found commonly in patients from African ancestry. The series comprises 20 consecutive patients treated surgically at three institutions from 1985 to 2002. Natural history, clinical presentation, histo-pathological findings, suspected aetiology, operative techniques, along with a discussion of the condition is presented. There were 10 female and 10 male patients and the mean age was 17+-6 (range 8-34) years. Patients were grouped as to the degree of posterior mitral annulus involvement by the aneurysm. In Group I, (n=12) a single aneurysm neck was found. In Group II, (n=3) multiple necks and in Group III, (n=5) involvement of the entire posterior annulus by teh aneurysm was found. Mean age in Group III (29 +/-5 years) was older than that of Groups I and II (15.5 +/- 4 years) suggesting a progressive nature of these aneurysms to enlarge. Clinically patients were in New YOrk Heart Association (NYHA) class I-IV. An intra-cardiac surgical approach was used in 11, extra-cardiac approach in two and a combined approach in seven patients. Mitral valve repair was attempted in 14 patients, with two intra-operative mitral valve repair failures. Failure to control the aneurysm neck (n=2) and failure of mitral valve repair (n=2) resulted in subsequent re-operation. There was no operative mortality. Histology of the aneurysm tissue suggested co-existing rheumatic heart disease in two, tuberculosis in four and infective endocarditis in two. Unknown or congenital disease was postulated in nine patients. Although LVSMA are thought to be congenital, 8 out of 20 patients (40%) had evidence of co-existent inflammatory pathology. The etiology of LVSMA remains uncertain. Many are thought to be congenital, but the findings in this study strongly support the view that rheumatic disease, chronic infections and malnutrition also play a role. A new classification is proposed based on the pathological findings. Involvement of the entire annulus in the older patients suggests a possible progressive nature of the disease. Surgery should be the difinitive therapy in all patients. Surgical approach must be individualized but the intra cardiac approach is suitable for the surgical repair in most cases. Success in mangement is dependent on the appropriate understanding of the relationship between aneurysm and valve.