An anatomopathologic study of membranous septum aneurysms and significance of their surgical treatment.
OBJECTIVE
We analyzed 14 patients with membranous septal aneurysms presenting with a left-to-right communication, by comparing the angiographic, operative and pathological findings. We decided to use medical treatment on two patients and operated on the rest (12 cases).


METHODS
The mean age of the patients was 19+/-9 yr; nine were female, five were male. Cine-angiography of all patients revealed a saccular abnormality protruding into the right ventricle at the uppermost part of the interventricular septum, just below the aortic valve. The sac had the appearance of a glove finger, a cauliflower, a diverticulum, or it was dome-shaped on angiography.


RESULTS
Perioperative exploration revealed a perforated true aneurysmal sac in seven patients. In three patients, the perimembranous tissues were severely fibrotic, thickened or had more than one perforation. Two patients had a defect under the septal leaflet of the tricuspid valve at the postero-inferior part of the septum, hidden between the chordae of the valve.


CONCLUSIONS
Defining the membranous septal abnormalities clearly is not always possible by cine-angiography. Echocardiography provides additional information. Pathological examination of the resected specimens showed almost total loss of elastic fibers and extensive accumulation of mucopolysaccharides.
Kaplan
M
M
Siyami Ersek Thoracic and Cardiovascular Surgery Center, Istanbul, Turkey. mehmetkaplan@superonline.com
Murat Demirtaş
M
M
Sayrak
H
H
Cimen
S
S
Dagsali
S
S
Ozler
A
A
D000293:Adolescent; D000328:Adult; D009202:Cardiomyopathies / Q000473:pathology* / Q000601:surgery; D002932:Cineangiography; D017023:Coronary Angiography; D005260:Female; D006322:Heart Aneurysm / Q000473:pathology* / Q000601:surgery; D006346:Heart Septum / Q000601:surgery; D006801:Humans; D008297:Male