Left ventricular submitral aneurysms

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dc.contributor.advisorHewitson, Johnen_ZA
dc.contributor.advisorLawrenson, Johnen_ZA
dc.contributor.authorDu Toit, Henningen_ZA
dc.date.accessioned2014-07-28T08:25:10Z
dc.date.available2014-07-28T08:25:10Z
dc.date.issued2007en_ZA
dc.descriptionIncludes bibliographical references (leaves 45-48).
dc.description.abstractRetrospective 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.en_ZA
dc.identifier.apacitationDu Toit, H. (2007). <i>Left ventricular submitral aneurysms</i>. (Thesis). University of Cape Town ,Faculty of Health Sciences ,Division of Cardiology. Retrieved from http://hdl.handle.net/11427/2778en_ZA
dc.identifier.chicagocitationDu Toit, Henning. <i>"Left ventricular submitral aneurysms."</i> Thesis., University of Cape Town ,Faculty of Health Sciences ,Division of Cardiology, 2007. http://hdl.handle.net/11427/2778en_ZA
dc.identifier.citationDu Toit, H. 2007. Left ventricular submitral aneurysms. University of Cape Town.en_ZA
dc.identifier.ris TY - Thesis / Dissertation AU - Du Toit, Henning AB - 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. DA - 2007 DB - OpenUCT DP - University of Cape Town LK - https://open.uct.ac.za PB - University of Cape Town PY - 2007 T1 - Left ventricular submitral aneurysms TI - Left ventricular submitral aneurysms UR - http://hdl.handle.net/11427/2778 ER - en_ZA
dc.identifier.urihttp://hdl.handle.net/11427/2778
dc.identifier.vancouvercitationDu Toit H. Left ventricular submitral aneurysms. [Thesis]. University of Cape Town ,Faculty of Health Sciences ,Division of Cardiology, 2007 [cited yyyy month dd]. Available from: http://hdl.handle.net/11427/2778en_ZA
dc.language.isoengen_ZA
dc.publisher.departmentDivision of Cardiologyen_ZA
dc.publisher.facultyFaculty of Health Sciencesen_ZA
dc.publisher.institutionUniversity of Cape Town
dc.subject.otherCardiothoracic Surgeryen_ZA
dc.titleLeft ventricular submitral aneurysmsen_ZA
dc.typeMaster Thesis
dc.type.qualificationlevelMasters
dc.type.qualificationnameMMeden_ZA
uct.type.filetypeText
uct.type.filetypeImage
uct.type.publicationResearchen_ZA
uct.type.resourceThesisen_ZA
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