Dear Label_Name,

Greetings! I hope you are well.

I am writing on behalf of an international publishing house, Science and Education Publishing, USA (http://www.sciepub.com).

Science and Education Publishing (SciEP) is a multidisciplinary open access publisher of Journals covering the fields of Science, Technology and Medicine. All SciEP publications are subject to high-quality peer review, editorial and production processes and are freely available online.

Welcome to the April, 2013 edition of SciEP newsletter, providing monthly summaries of articles on science & education related topics of interest to scientist and professionals. The mission of our journals is to provide an open access forum for publishing new findings on issues pertinent to scientific and academic field. We also invite you to submit original research papers, review articles, short reports, or case studies are considered for publication in our Multidisciplinary Journals.

American Journal of Public Health Research
DOI: 10.12691/ajphr-1-1-3

The Implementation of a Tele-Homecare System with Service Oriented Architecture and HL7 Message Transmission Standard
Ching-Sung Wang

American Journal of Medical and Biological Research
DOI: 10.12691/ajmbr-1-1-2

The Influence of Ethanol on Pyruvate Kinases Activity in Vivo, in Vitro, in Silico
Lelevich Sergey Vladimirovich, Khrustalev Vladislav Victorovich, Barkovsky Eugene Victorovich, Shedogubova Tatyana Aleksandrovna

American Journal of Medical Sciences and Medicine
DOI: 10.12691/ajmsm-1-1-1

Clinical and Histological Features in Wegener Granulomatosis
Li Cavoli Gioacchino, Passantino Rita, Bono Luisa, Tortorici Calogera, Ferrantelli Angelo, Giammarresi Carlo, Rotolo Ugo

American Journal of Infectious Diseases and Microbiology
DOI: 10.12691/ajidm-1-1-2

The Curse of Lymphatic Filariasis: Would the Continual Use of Diethylcarbamazine Eliminate this Scourge in Papua New Guinea?
Anne Lanham, Lillian Mwanri

We have released issues of some journals on February 2013.
American Journal of Public Health Research
American Journal of Medical Sciences and Medicine
American Journal of Medical and Biological Research
American Journal of Pharmacological Sciences
American Journal of Clinical Medicine Research
American Journal of Nursing Research
American Journal of Cancer Prevention
American Journal of Medicine Studies
American Journal of Infectious Diseases and Microbiology
American Journal of Cardiovascular Disease Research
American Journal of Biomedical Research
American Journal of Mechanical Engineering
American Journal of Microbiological Research
Journal of Preventive Medicine
American Journal of Food and Nutrition
American Journal of Hypertension Research
American Journal of Sports Science and Medicine
Journal of Cancer Research and Treatment
American Journal of Zoological Research
Journal of Biomedical Engineering and Technology
American Journal of Microbiological Research
Biomedical Science and Engineering

We are pleased to announce that submissions are now being accepted for peer review for all the journals across all our subject areas in SciEP.

Please submit your manuscript via our online submission system:
http://www.sciepub.com/author/signin

To unsubscribe from our mailing list, please click on the following link: unsubscribe

I am looking forward to hearing from you.

Kind regards,

David Rain
Email:join@sciepub.com
Science and Education Publishing (http://www.sciepub.com)

Submitral Aneurysm: A Rare Congenital Anomaly

Manish Ruhela*, Dinanath kumar, Chandra Bhan Meena, Rajeev Bagarhatta

Department of Cardiology, SMS Medical College and Hospital, Jaipur, Rajasthan, India

Abstract: Submitral aneurysm is a congenital out pouching of the left ventricular wall invariably occurring adjacent to the posterior mitral leaflet. This rare congenital cardiac anomaly was initially described among the African population and is considered rare in the other parts of world. The clinical picture is dominated by congestive cardiac failure in the presence of mitral regurgitation. Echocardiography provides precise non-invasive diagnosis. The literature is reviewed to increase the awareness of clinicians, especially novice echocardiographers about this rare cardiac anomaly when coming across congestive cardiac failure with mitral regurgitation in young population.

Keywords: submitral aneurysm, congenital anomaly, mitral regurgitation

Received May 22, 2014; Revised June 11, 2014; Accepted June 16, 2014

Citation: Manish Ruhela, Dinanath kumar, Chandra Bhan Meena, Rajeev Bagarhatta, Submitral Aneurysm: A Rare Congenital Anomaly. American Journal of Medical Case Reports, 2 (6). 114-116. January 2014. doi:10.12691/ajmcr-2-6-1

1. Introduction

Submitral left ventricular aneurysm is a rare cardiac anomaly, recognized but with relatively sparse description in the literature. It was first reported from Nigeria and other African countries by Abrahams et. al where 12 patients with an unusual form of left ventricular aneurysm were described which they termed as "annular left ventricular aneurysm" [1]. Submitral aneurysm (SMA) is a congenital out-pouching of left ventricular wall, invariably occurring adjacent to the posterior leaflet of mitral valve [2]. Most of the cases of subvalvular left ventricular aneurysms described in the literature are due to congenital weakness of the fibro-muscular annuli. Chesler and colleagues postulate that a dehiscence of the fibro-muscular union will result in aneurysm formation. [3] Cases have been described mainly from African countries but few case reports from India as well [4]. We report this case from the department of Cardiology, SMS Medical college, Jaipur, Rajasthan, India. This is the first case report of submitral aneurysm from the western part of India. Our case highlights the importance of considering SMA in the differential diagnosis of mitral regurgitation with left ventricular dysfunction and heart failure in young patients.

Figure 1. Transthoracic echocardiography ( Parasternal long axis view ) showing submitral aneurysm below posterior mitral leaflet

2. Case Report

A 18 year old boy presented to cardiology OPD with progressively worsening dyspnea and palpitations for the last two year and history orthopnea for 7 days. There was no history suggestive of rheumatic fever. On examination he had a heart rate of 110/ minute, blood pressure of 108/60 mm Hg, raised jugular venous pressure (9 cms above the angle of Louis) and pedal edema. The apex was in the 6th left ICS, 2 cms outside the mid-clavicular line. On auscultation, S1 soft and LVS3 were present. A Grade 4/6 pan-systolic murmur radiating towards the axilla was heard. There was also a pan-systolic murmur in the left 3rd parasternal region which increased during inspiration. Chest auscultation revealed bilateral basal crepitations. Abdominal examination revealed tender hepatomegaly (liver span 15 cms). ECG showed sinus tachycardia. Chest X- ray revealed cardiomegaly with evidence of pulmonary venous congestion. On transthoracic echocardiography, the significant finding was a submitral aneurysm(Figure 1, Figure 2) in the postero-lateral wall of the left ventricle. The patient also had severe mitral regurgitation with an eccentric jet with dilatation of the left atrium and left ventricle (Figure 3). He was also found to have severe tricuspid regurgitation (Figure 4). Left ventricular Ejection fraction was 48% and minimal pericardial effusion was also present. So, the diagnosis of submitral aneurysm was made and patient was stabilized with decongestive therapy and then refer to cardiothoracic department for further management.

Figure 2. Transthoracic echocardiography ( Apical 4 chamber view ) showing submitral aneurysm and pericardial effusion.

Figure 3. Transthoracic colour Doppler echo showing mitral regurgitation and flow into submitral aneurysm.

Figure 4. Transthoracic colour Doppler echo showing Tricuspidl regurgitation and submitral aneurysm

3. Discussion

Submitral aneurysm is rare and most cases have been described in black and Negroid people. Sub –mitral aneurysm was first described in 1812 by Corvisart and, since then, only 100-120 cases of these aneurysms have been reported worldwide. [5] Sporadic case reports in the last two decades have documented their existence in the Indian population also. Even though the etiology of the condition is thought to be a congenital, co-existence of the condition with Takayasu's arteritis [6] and tuberculous pericarditis [7] has been reported. Although it can present as life threatening complications such as ventricular tachycardia due to compression of the left main coronary artery, the most common presentation is severe mitral regurgitation [8]. Doppler echocardiography has proved to be a useful technique for the noninvasive diagnosis of submitral aneurysms in the clinical setting. Management of submitral aneurysm involves initial medical stabilization with diuretics and afterload reducing agents. Surgical repair is the definitive treatment and includes pericardial patch repair6, valvuoplasty through a transmitral approach [9], transatrial repairs with sutures [10], or mitral valve replacement [11]. Mortality is high in un-operated cases and operative repair under cardiopulmonary bypass is the most appropriate management. Post-operative outcome is directly related to size of the aneurysm and severity of LV dysfunction.

In conclusion, submitral aneurysm, although uncommon, should always be considered in the list of differential diagnosis in young patients presenting with a murmur suggestive of mitral insufficiency or signs and symptoms of heart failure. The definitive diagnosis is made by transthoracic echocardiography in the presence of an aneurismal dilatation in submitral location behind the posterior mitral leaflet that communicated with the left ventricular cavity through one or more necks. Novice echocardiographers should aware about this rare cardiac anomaly when coming across congestive cardiac failure with mitral regurgitation in young population.

Statement of Competing Interests

Authors have no competing interests.

References

[1]   | Abrahams DG, Barton CJ, Cockshott WP, et al. Annular subvalvular left ventricular aneurysms. Quart J Med 1962; 31: 345-360.
[2]   | Antunes MJ. Submitral left ventricular aneurysms. Correction by a new transatrial approach. J Thorac Cardiovasc Surg 1987; 94: 241-245.
[3]   | Chesler, E., Mitha, A.S., and Edwards, J.E. Congenital aneurysms adjacent to the annuli of the aortic and/or mitral valves. Chest. 1982; 82: 334-337.
[4]   | Chockalingam A, Gnanavelu G, Alagesan R, Subramaniam T. Congenital submitral aneurysm. Echocardiography 2004; 21: 325-328.
[5]   | Deshpande AV, Vaidya SV, Kumar A. Submitral aneurysm. Heart 2004; 90: 988.
[6]   | Rose AG, Folb J, Sinclair Smith CC, Schneider JW. Idiopathic annular submitral aneurysm associated with Takayasu's arteritis. Arch Pathol Lab Med 1995; 119: 831-5.
[7]   | Sharma S, Daxini BV, Loya YS. Profile of Submitral Left Ventricular Aneurysm in Indian Patients. IHJ 1990; 42: 153-6.
[8]   | Ruiz D, Domigo P, Canalis E, Mata J. Annular submitral left ventricular aneurysm. Eur Heart J 1992; 13: 424-425.
[9]   | Janeira LF, Talit U, Parker R, Hughes CE, Tuna IC. Surgical management of ventricular tachycardia in sub annular left ventricular aneurysm. Ann Thorac Surg 1995; 60: 438-40.
[10]   | Sutorius DJ, Helmsworth JA, Majeski JA, Miller SF. Repair of a subvalvular left ventricular aneurysm following mitral valve replacement. Ann Thorac Surg 1981; 32: 92-6.
[11]   | Almeida – Filho OC, Schmidt A, Sgarbieri R, Marin- Neto JA,, Maciel BC. Large submitral left ventricular aneurysm associated with mitral valveaneurysm. Echocardiography 2002; 19:391-3.