Left Ventricular Pseudoaneurysm as a Complication of Myocardial Infarction; A Case Series and Review of the Literature (original) (raw)
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Left Ventricular Pseudoaneurysm and Rupture After Limited Myocardial Infarction
Journal of the American Society of Echocardiography, 2005
A 50-year-old man had a large lateral left ventricular wall pseudoaneurysm with rupture after a limited myocardial infarction. This was diagnosed by the combination of flow in and out of the aneurysm and pulsatile flow in the pericardial cavity using color flow and continuous wave Doppler ultrasound. This report describes the case management, the use of echocardiography in this setting, and the implications of pseudoaneurysm formation. (J Am Soc Echocardiogr 2005;18:980.e1-4.)
Cardiac Surgery and Follow-up Diagnosis of the Left Ventricular Pseudoaneurysm Patient
Left ventricular pseudoaneurysms (LVP) are false aneurysms caused by the rupture of left ventricular wall as a complication of myocardial infarction, cardiac surgery, congenital heart disease, and, more rarely endocarditis. It is a rare condition that initiates 3-14 days are myocardial infarction affecting 0.5% of the patients. The known risk factors to develop LVP are age, history of hypertension, deficiency of collateral circulation after myocardial infarction, and female gender. The current case report describes LVP in a 58-year old male patient with frontal acute myocardial infarction history. The patient was diagnosed using ECG, CINE-MRI, DE-IR analysis, and thorax-CT followed by urgent cardiac surgery. The diagnosis was an apical pseudoaneurysm caused by previous myocardial necrosis. The Immunohistochemistry suggested cardiac fibrosis. The patient was discharged asymptomatic for angina pectoris, dyspnea and palpitations, and prescribed warfarin against clotting, β-blocker/vasodilator, furosemide diuretic, angiotensin receptor blocker, and proton pump inhibitor medication. After six months of follow-up, the patient demonstrated the absence of preoperative symptoms.
2016
Introduction: Left ventricular (LV) pseudoaneurysms are a rare and challenging clinical problem. Defined as a contained rupture of the left ventricular wall and most commonly caused by myocardial infarction (MI), patients generally present with chest pain, congestive heart failure, or dyspnea. Diagnosis is usually achieved through use of either echocardiography or angiography. Management is generally operative. Case Series: We sought to examine our experience in the management of LV pseudoaneurysms with the goal of describing the diverse presentation of this disease, along with our individualized management. We report a retrospective case series of four patients who presented to our center with LV pseudoaneurysm, all of which were managed operatively. All four patients underwent successful repair with 100% short-term survival. Conclusion: Early diagnosis and an individualized operative approach is critical in the management of left ventricular pseudoaneurysm.
Surgical treatment of post-infarction left ventricular pseudoaneurysm: a two-decade experience
Texas Heart Institute journal / from the Texas Heart Institute of St. Luke's Episcopal Hospital, Texas Children's Hospital, 2007
Herein, we present a retrospective analysis of our experience with acquired pseudoaneurysms of the left ventricle over a 20-year period.From February 1985 through September 2004, 14 patients underwent operation for left ventricular pseudoaneurysm in our clinic. All pseudoaneurysms (12 chronic, 2 acute) were caused by myocardial infarction. The mean interval between myocardial infarction and diagnosis of pseudoaneurysm was 7 months (range, 1-11 mo). The pseudoaneurysm was located in the inferior or posterolateral wall in 11 of 14 patients (78.6%). In all patients, the pseudoaneurysm was resected and the ventricular wall defect was closed with direct suture (6 patients) or a patch (8 patients). Most patients had 3-vessel coronary artery disease. Coronary artery bypass grafting was performed in all patients. Five patients died (postoperative mortality rate, 35.7%) after repair of a pseudoaneurysm (post-infarction, 2 patients; chronic, 3 patients). Two patients died during follow-up (me...
Left ventricular pseudoaneurysm formation: Two cases and review of the literature
World journal of clinical cases, 2014
Left ventricular wall rupture (LVWR) comprises a complication of acute myocardial infarction (AMI). Acute LVWR is a fatal condition, unless the formation of a pseudoaneurysm occurs. Several risk factors have been described, predisposing to LVWR. High index of suspicion and imaging techniques, namely echocardiography and computed tomography, are the cornerstones of timely diagnosis of the condition. As LVWR usually leads to death, emergency surgery is the treatment of choice, resulting in significant reduction in mortality and providing favorable short-term outcomes and adequate prognosis during late follow-up. Herein, we present two patients who were diagnosed with LVWR following AMI, and subsequent pseudoaneurysm formation. In parallel, we review the aforementioned condition.
Surgical Treatment of Left Ventricular Pseudoaneurysm
Medical Archives, 2014
Introduction: Left ventricular pseudoaneurysm is a rare condition because in most instances ventricular free-wall rupture leads to fatal pericardial tamponade. Rupture of the free wall of the left ventricle is a cata strophic complication of myocardial infarction, occurring in approximately 4% of pa tients with infarcts, resulting in immediate collapse of the patient and electromechanical dissociation. In rare cases the rupture is contained by pericardial and fibrous tissue, and the result is a pseudoaneurysm. The left ventricular pseudoaneurysm contains only pericardial and fibrous elements in its wall-no myocardial tissue. Because such aneurysms have a strong tendency to rupture, this disorder may lead to death if it is left surgically untreated. Case report: In this case report, we present a patient who underwent successful repair of a left ventricular pseudoaneurysm, which followed a myocardial infarction that was caused by occlusion of the left circumflex coronary artery. Although repair of left ventricular pseudoaneurysm is still a surgical challenge, it can be performed with acceptable results in most patients.
Pseudoaneurysm originating from left ventricle aneurysm: An autopsy case and review of literature
Journal of Forensic and Legal Medicine, 2013
Rupture of the free wall of the left ventricle is a catastrophic complication of acute myocardial infarction. Rarely, free wall rupture is contained by overlying adherent pericardium, producing a pseudoaneurysm of the left ventricle. In this report, a case of a left ventricular pseudoaneurysm due to a previous myocardial infarction is described. A 55-year-old woman had a severe chest pain 11 months prior to death. No cardiac investigation was performed. Three days prior to death, she suffered from fatigue and weakness, and had a witnessed sudden cardiac death. At autopsy, a 8.5 x10 x 8 cm pseudoaneurysm of the left ventricle was found. There was severe coronary artery atherosclerosis. There were extensive adhesions between pericardium and pseudoaneurysm wall. The cause of death was attributed to heart failure and resulting arrhythmia. The case illustrates the rare event of left ventricular pseudoaneurysm first diagnosed at forensic autopsy.
Left ventricular pseudoaneurysm after myocardial infarction
Heart and Vessels, 2003
In this report, a case of a left ventricular (LV) pseudoaneurysm due to a previous myocardial infarction, which was repaired successfully, is described. A 62-year-old man, with a history of acute anterior wall myocardial infarction 6 months previously, was admitted with the complaints of acute dyspnea and palpitation. Echocardiography revealed an LV aneurysm, and ventriculography showed ventricular dysfunction and an LV pseudoaneurysm. Coronary angiography showed total occlusion of the proximal segment of the left anterior descending artery with a very thin lumen and insufficient retrograde filling. Under cardiopulmonary bypass and beating heart, the pseudoaneurysm was resected and the defect on the ventricular free wall was closed by the remodeling ventriculoplasty method of Dor. Histopathologic examination of the resected material confirmed the diagnosis of pseudoaneurysm. The postoperative course of our patient was uneventful. He was discharged on the ninth postoperative day.
Left ventricular pseudoaneurysm
Journal of the American College of Cardiology, 1998
Left ventricular (LV) pseudoaneurysms form when cardiac rupture is contained by adherent pericardium or scar tissue. Although LV pseudoaneurysms are not common, the diagnosis is difficult and they are prone to rupture. We evaluated the clinical presentation, diagnostic accuracy of imaging modalities, results of therapy and prognosis of 290 patients with LV pseudoaneurysms. Most cases of LV pseudoaneurysm were related to myocardial infarction (particularly inferior wall myocardial infarction) and cardiac surgery. Congestive heart failure, chest pain and dyspnea were the most frequently reported symptoms, but >10% of patients were asymptomatic. Physical examination revealed a murmur in 70% of patients. Almost all patients had electrocardiographic abnormalities, but these were usually nonspecific ST segment changes; only 20% of patients had ST segment elevation. Although radiographic findings were also usually nonspecific, the appearance of a mass was present in more than one half of patients and may be an important clue to the correct diagnosis. Left ventricular angiography was the most definitive test and can be useful in planning surgery since concomitant coronary angiography can be performed. Regardless of treatment, patients with LV pseudoaneurysms had a high mortality rate, especially those who did not undergo surgery. Because the symptoms, signs, electrocardiographic abnormalities and radiographic findings seen in patients with LV pseudoaneurysms can be indistinguishable from those in patients with coronary disease alone, a high clinical index of suspicion is needed to avoid missing the diagnosis.