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Tricuspid pouch can cause systemic embolization in adulthood.
Akira Takaki1, Hiroshi Ogawa, Takatoshi Wakeyama
1Division of Cardiology, Tokuyama Central Hospital, Shunan, USA. atakaki@msf.biglobe.ne.jp
Summary
A cardiac aneurysm initially suspected in a stroke patient was misdiagnosed. Surgery revealed a tricuspid valve anomaly, not an aneurysm of the membranous septum, was the cause of the embolism.
Area of Science:
- Cardiology
- Neurology
- Cardiac Surgery
Background:
- A 63-year-old male presented with left hemiplegia, a history of transient ischemic attack, and computed tomography findings suggestive of a cerebral event.
- Initial investigations including echocardiography and left ventricular angiography indicated an aneurysm of the membranous septum (AMS) as the likely source of embolism.
- The patient's presentation mimicked stroke secondary to cardiac embolism.
Observation:
- Computed tomography revealed hypodensity along the right lateral ventricle correlating with the patient's left-sided paralysis.
- Echocardiography and left ventricular angiography identified an aneurysm of the membranous septum (AMS) but no ventricular septal defect (VSD).
Findings:
- Surgical exploration determined that the AMS was not the source of the embolism.
- The actual cause was identified as a large, 2.0 cm pouch formed by the septal leaflet of the tricuspid valve during the natural closure of a VSD.
- This tricuspid valve anomaly mimicked the appearance of an AMS.
Implications:
- This case highlights the importance of comprehensive diagnostic evaluation in suspected cardiac embolism.
- Tricuspid valve anomalies can present atypically and may be misidentified as other cardiac conditions.
- Accurate differentiation between AMS and tricuspid valve abnormalities is crucial for appropriate management and treatment of embolic events.