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Pulmonary sequestration presenting as mitral valve insufficiency
B Kimbrell1, T Degner, P Glatleider
1Kaiser Permanente Medical Center, Los Angeles, California 90027, USA.
Insights
Pulmonary sequestration can cause heart problems like mitral regurgitation due to abnormal blood flow. Surgical removal of the sequestration resolved the cardiac issues, avoiding the need for heart surgery.
Area of Science:
- Cardiology
- Thoracic Surgery
- Pediatric Medicine
Background:
- Pulmonary sequestration, a rare congenital lung malformation, typically presents with recurrent infections.
- Cardiac complications, particularly those related to high-flow shunts, are uncommon presentations of pulmonary sequestration.
Observation:
- A 4-year-old girl presented with symptoms suggestive of primary cardiac disease, including left atrial and ventricular enlargement and severe mitral regurgitation.
- Cardiac catheterization and angiography revealed an unexpected large aortopulmonary shunt through an intralobar pulmonary sequestration.
Findings:
- The patient underwent successful lobectomy, removing the pulmonary sequestration and the aortopulmonary shunt.
- Post-operatively, significant improvement in cardiac chamber size and function was observed over a 2.5-year follow-up period.
Implications:
- This case highlights that pulmonary sequestration can manifest as a high-flow cardiac lesion, mimicking primary heart disease.
- Thorough evaluation of chest imaging is crucial for diagnosing pulmonary sequestration presenting with cardiac symptoms, potentially preventing unnecessary cardiac surgery.
Abstract:
Although pulmonary sequestrations commonly present with infectious complications, problems relating to high blood flow through the lesion are rarely apparent. A 4-year-old girl was referred for cardiac catheterization and evaluation for mitral valve surgery. An echocardiogram had demonstrated left atrial and ventricular enlargement and significant mitral regurgitation with an enlarged valve annulus. Angiography results showed a very large aorta to left atrial shunt through an unsuspected intralobar sequestration. Lobectomy with removal of the sequestration resulted in significant improvement in cardiac chamber size and function over a 2.5-year follow-up period, thus obviating the need for cardiac surgery and removing a potential source of infection. Careful evaluation of chest imaging studies will lead to the correct diagnosis and treatment in patients with pulmonary sequestration who are thought initially to have primary cardiac disease.