Annular subaortic aneurysms are not common, and are usually situated in the mitro-aortic intervalvular fibrosa (MAIVF) region. We present a ruptured annular subaortic aneurysm with left ventricular outflow tract to left atrial communication submitted to a successful surgical repair. An 18-year-old man developed a septic shock in april-1996 with meningitis and intra-venous disseminated coagulation, but without evidence of infective endocarditis. Blood cultures grew Staphylococcus aureus. In march 1997, a mitral systolic ejection murmur was noted. Transthoracic and transesophageal echocardiography showed a bicuspid aortic valve, a prolapsed anterior mitral leaflet, and an annular subaortic aneurysm at MAIVF with left ventricular tract to left atrial communication. Cardiac catheterization confirmed left ventricular to left atrial shunt, but no aneurysmatic structure was seen. Cardiac operation with cardiopulmonary bypass was performed on May 1997. The left atrium was opened. An annular subaortic aneurysm was present in the area of MAIVF and measured 1.8 cm in extension. Its neck measured 1.0 cm. A fibrous-thin-walled aneurysm (fibrous sac) extended into the left atrium and its extremity was perforated . The aneurysm was resected and its neck was plicated using pledgeted sutures. Valve replacement was not necessary. The postoperative course was uneventful, and the patient was discharged on the seventh postoperative day. Echocardiogram at discharge showed normal function of aortic and mitral valves and no residual shunt. Concluding, a successful surgical repair of annular subaortic aneurysm is possible, with out valve replacement, and with no residual shunt.
Aortic aneurysm; Aortic aneurysm
