AN ANATOMOPATHOLOGIC STUDY OF MEMBRANOUS SEPTUM ANEURYSMS AND IMPORTANCE OF THEIR SURGICAL TREATMENT

Mehmet KAPLAN, Murat DEMİRTAŞ, Serdar ÇİMEN, Murat AKÇAR, Sabri DAĞSALLI, Azmi ÖZLER, *Hakan SAYRAK

Dr. Siyami Ersek Göğüs Kalp Damar Cerrahisi Merkezi, İSTANBUL,
^{*^{SSK Göztepe Eğitim Hastanesi Patoloji Anabilim Dalı, İSTANBUL}}

We analysed 14 cases presenting with an aneurysmal formation of the membranous septum and a left-to-right communication by comparing angiographic, operative and pathological findings. We decided to apply medical treatment in 2 cases and surgical treatment in 12 cases. The mean age of the patients was 19 ± 9 years and nine of them were female, 5 were male. Cine-angiographies of all patients revealed a sac image protruding to the right ventricle at the most upper part of the inventricular septum, just below the aortic valve.

Anigographically the sac was like a glove-finger, a cauliflower, a diverticulum, or dome-shaped. Perioperative exploration of 7 cases revaled a perforated true aneurysmal sac. In three patients, perimembranous tissues were severely fibrotic, thickened or having more than one perforations. Two patients possessed 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. Defining clearly the membranous septum pathologies is not always possible, by cine-angiography. Echocardiography provides additional information for operative decision. Pathological examination of the resected specimens showed almost total loss of elastic fibers and extensive accumulation of mucopolysaccharides.

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