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Electrical and mechanical components of dyssynchrony in heart failure patients with normal QRS duration and left bundle-branch block: impact of left and biventricular pacing. Circulation 2004;109: 2544–2549. Clinical vignette doi:10.1093/eurheartj/ehm178 Online publish-ahead-of-print 26 June 2007 Late pulmonary artery aneurysm combined with subpulmonary left ventricular outﬂow tract obstruction in corrected transposition of the great arteries Jan Dominik1, Karel Medilek1, Pavel Zacek1*, and Josef Stasek2 1 Department of Cardiac Surgery, Faculty of Medicine, Charles University Prague, University Hospital, Sokolska tr. 50, Hradec Kralove 500 05, Czech Republic and 2Department of Internal Medicine, Faculty of Medicine, Charles University Prague, University Hospital, Sokolska tr. 50, Hradec Kralove 500 05, Czech Republic * Corresponding author. Tel: þ42 49 5832143; fax: þ42 49 511953. E-mail address: [email protected] A 57-year-old male was admitted due to exertional dyspnoea and fatigue, which are the ﬁrst symptoms of congenitally corrected transposition of the great arteries. Unusual combination of subpulmonary obstruction caused by membranous ventricular septal aneurysm and a large pulmonary artery aneurysm was diagnosed by cineangiography (Panel A) and echocardiography (Panel B, D). The defects (Panel C) were successfully corrected by reduction pulmonary arterioplasty and interventricular septal aneurysm repair. Post-operative course was uneventful and the patient is free of symptoms at 3 months of follow-up. Panel A. Right ventriculography in left anterior oblique view: aneurysm of the membranous interventricular septum bulging into the subpulmonary left ventricular outﬂow tract. Panel B. Transthoracic echocardiography, four-chamber view in zoom: interventricular septum (IVS), aneurysm of membranous IVS (asterisk) causing outﬂow tract obstruction (arrow), right atrium (RA), and pulmonary valve (PV). Panel C. Median sternotomy: typical transpositional morphology of the great arteries with a large pulmonary artery aneurysm (8 cm in diameter). Pulmonary artery (PA), aorta (Ao), and right atrium (RA). Panel D. Transthoracic echocardiography, modiﬁed short-axis view: pulmonary artery aneurysm. Downloaded from by guest on November 7, 2014 11. Gavazzi A, De Maria R, Porcu M, Beretta L, Casazza F, Castelli G, Luvini M, Parodi O, Recalcati F, Renosto G. Dilated cardiomyopathy: a new natural history? The experience of the Italian Multicenter Cardiomyopathy Study (SPIC). G Ital Cardiol 1995;25:1109–1125. 12. Juilliere Y, Barbier G, Feldmann L, Grentzinger A, Danchin N, Cherrier F. 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