1
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Binder MS, Williams E, Heletz I. An isolated mid-anterolateral wall true ventricular aneurysm due to coronary artery disease. Echocardiography 2023; 40:1300-1304. [PMID: 37837610 DOI: 10.1111/echo.15703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Accepted: 10/10/2023] [Indexed: 10/16/2023] Open
Abstract
Aneurysms following a myocardial infarction usually involve the apical wall segments. We present a case of a rare isolated mid-anterolateral wall aneurysm due to occlusion of a diagonal branch. We review the echocardiographic criteria for diagnosing a left ventricular (LV) aneurysm and discuss how to differentiate one from a more critical pseudoaneurysm. We demonstrate the utility of using ultrasound enhancing contrast and review imaging protocols for ruling out associated LV thrombus.
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Affiliation(s)
- M Scott Binder
- Department of Cardiology, Virginia Tech Carilion Roanoke Memorial Hospital, Roanoke, USA
| | - Eric Williams
- Department of Cardiology, Virginia Tech Carilion Roanoke Memorial Hospital, Roanoke, USA
| | - Ido Heletz
- Department of Cardiology, Virginia Tech Carilion Roanoke Memorial Hospital, Roanoke, USA
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2
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Yamanaka R. A Case of an Apical Aneurysm Caused by a Cardiac Event Involving Noncoronary Collateral Blood Flow. Cureus 2023; 15:e43520. [PMID: 37719575 PMCID: PMC10501322 DOI: 10.7759/cureus.43520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/15/2023] [Indexed: 09/19/2023] Open
Abstract
An 87-year-old man presented with exertional dyspnea and was admitted due to congestive heart failure. Echocardiography and left ventriculography performed after his condition improved showed an aneurysm at the left ventricular apex. However, coronary angiography showed no significant lesions and an avascular field at the apex. Computed tomography angiography revealed that the enlarged left inferior phrenic artery reached the heart and nourished the apex wall where the aneurysm was present. Looking back retrospectively, he was previously hospitalized nine years ago for epigastric pain with elevated myocardial deviation enzymes and electrocardiographic changes but no coronary artery lesions. Moreover, abnormal vascularization had already been observed 13 years ago when the aneurysm did not exit. Considering these findings, we concluded that the ventricular aneurysm in this case was caused by a vascular event involving collateral circulation from outside the heart.
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3
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Hrycek E, Walawska-Hrycek A, Szymański R, Stoliński J, Nowakowski P, Żurakowski A. Giant left ventricular inferior wall aneurysm as a late complication after myocardial infarction: A case report. Echocardiography 2023; 40:259-265. [PMID: 36597587 DOI: 10.1111/echo.15512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2022] [Revised: 11/15/2022] [Accepted: 11/30/2022] [Indexed: 01/05/2023] Open
Abstract
A case of a 64-year-old patient who was referred to interventional cardiology unit in order to qualify her to mitral valve repair is presented. Transthoracic echocardiography revealed a giant inferior wall basal aneurysm of the left ventricle (44 mm × 31 mm, 57 ml) and coronary angiography revealed chronic total occlusion of the proximal right coronary artery. The patient refused surgical treatment and was treated with pharmacotherapy alone. At 1 year follow-up, clear progression of the disease was observed. Based on this case study, we would cautiously suggest that in similar cases of large inferobasal wall aneurysms causing severe MR, OMT may be insufficient to prevent disease progression, and that early surgical intervention may be preferred.
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Affiliation(s)
- Eugeniusz Hrycek
- American Heart of Poland, Chrzanów, Poland.,Department of Cardiology, Faculty of Medical Sciences, Andrzej Frycz Modrzewski Kraków University, Kraków, Poland
| | - Anna Walawska-Hrycek
- Department of Neurology, Faculty of Medical Sciences in Katowice, Medical University of Silesia, Katowice, Poland
| | | | | | - Przemysław Nowakowski
- American Heart of Poland, Chrzanów, Poland.,University of Technology, Katowice, Poland
| | - Aleksander Żurakowski
- American Heart of Poland, Chrzanów, Poland.,Department of Cardiology, Faculty of Medical Sciences, Andrzej Frycz Modrzewski Kraków University, Kraków, Poland
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4
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Repair of left ventricular aneurysm in the setting of noncompaction. J Cardiol Cases 2022; 25:416-419. [DOI: 10.1016/j.jccase.2022.01.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Revised: 12/29/2021] [Accepted: 01/21/2022] [Indexed: 11/19/2022] Open
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5
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Amaqdouf S, Rasras H, Hbali A, Boulouiz S, Ismaili N, El Ouafi N. Submitral aneurysm: An unusual localization of aneurysm complicating a myocardial infarction: A case report. Ann Med Surg (Lond) 2021; 72:103042. [PMID: 34868571 PMCID: PMC8626648 DOI: 10.1016/j.amsu.2021.103042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Revised: 11/03/2021] [Accepted: 11/09/2021] [Indexed: 12/01/2022] Open
Abstract
Introduction and importance: Submitral aneurysms are an uncommon heart condition that is widespread among young black Africans, congenital etiology is the most common, when SMA is found in patients of other races, other etiologies must be sought, especially ischemic. Case presentation We present the case of a 65-year-old male patient admitted for wide complex tachycardia at a rate of 198 bpm, in whom transthoracic echocardiography revealed a submitral aneurysm and coronary angiography revealed an occlusion of the left circumflex artery. Clinical discussion Submitral left ventricular aneurysm is a rare cardiac pathology with a variety of causes including inflammation, infection, traumatic illness, or, in rare cases, ischemic heart disease; it can be caused by a congenital defect in the posterior portion of the mitral annulus, which is more common in African population. Clinical manifestations are frequently serious and alarming, such as ventricular tachycardia, cardiogenic shock or an embolic phenomenon; however, asymptomatic cases are possible. Conclusion What we can retain from our case is that SMA can be the cause or consequence of coronary ischemia, so we must be vigilant in patients with an atypical clinical presentation. Submitral aneurysms are a rare cardiac abnormality They are more common in young black Africans Congenital etiology is the most implicated but when they are found in other races, other possible etiologies must be researched.
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Affiliation(s)
- Saîda Amaqdouf
- Department of Cardiology, Mohammed VI University Hospital of Oujda, Mohammed First University of Oujda, Morocco
| | - Hammam Rasras
- Department of Cardiology, Mohammed VI University Hospital of Oujda, Mohammed First University of Oujda, Morocco
| | - Anas Hbali
- Department of Cardiology, Mohammed VI University Hospital of Oujda, Mohammed First University of Oujda, Morocco
| | - Soumia Boulouiz
- Department of Cardiology, Mohammed VI University Hospital of Oujda, Mohammed First University of Oujda, Morocco
| | - Nabila Ismaili
- Department of Cardiology, Mohammed VI University Hospital of Oujda, Mohammed First University of Oujda, Morocco.,Laboratory of Epidemiology, Clinical Research and Public Health, Faculty of Medicine and Pharmacy, Mohammed the First University of Oujda, Morocco
| | - Noha El Ouafi
- Department of Cardiology, Mohammed VI University Hospital of Oujda, Mohammed First University of Oujda, Morocco.,Laboratory of Epidemiology, Clinical Research and Public Health, Faculty of Medicine and Pharmacy, Mohammed the First University of Oujda, Morocco
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6
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Kong A, Ramirez Damera R, Perez Buitrago A, Nguyen HC, Hussain ST. A Growing Two-Decade-Old True Left Ventricular Aneurysm: A Case Report. Cureus 2021; 13:e18792. [PMID: 34804658 PMCID: PMC8592315 DOI: 10.7759/cureus.18792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Accepted: 10/14/2021] [Indexed: 11/05/2022] Open
Abstract
Left ventricular aneurysms (LVA) occur after an infarcted area of the myocardium necrotizes, fibroses, and expands, forming a dyskinetic cavity. Most ventricular aneurysms are asymptomatic and go unrecognized unless found incidentally. Symptoms commonly reported include angina, heart failure, syncope, and even sudden cardiac death. Late complications from left ventricular aneurysms are infrequently reported. This case reports an elderly woman who presented with new-onset angina from an expanding 18-year-old true left ventricular aneurysm that was successfully treated with surgical repair.
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Affiliation(s)
- Alexander Kong
- Internal Medicine, University of Central Florida-HCA Healthcare Graduate Medical Education (GME), Orlando, USA
| | - Ramses Ramirez Damera
- Internal Medicine, University of Central Florida-HCA Healthcare Graduate Medical Education (GME), Orlando, USA
| | | | - Hiep C Nguyen
- Cardiothoracic Surgery, University of Central Florida College of Medicine, Orlando, USA
| | - Sayed T Hussain
- Cardiology, University of Central Florida College of Medicine, Orlando, USA
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7
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Donuru A, Saul D, Parekh M, Kumaran M, Kandula V, Kharouf R. Gunshot-Related Pediatric Left Ventricular Apical Aneurysm. JACC Case Rep 2021; 3:26-30. [PMID: 34317463 PMCID: PMC8305065 DOI: 10.1016/j.jaccas.2020.10.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Revised: 09/30/2020] [Accepted: 10/19/2020] [Indexed: 11/17/2022]
Abstract
Penetrating injuries of the thorax and abdomen, such as gunshot and stabbing, are rare in children. We present the case of a pediatric patient with a history of remote gunshot injury presenting with a late aneurysm in the left ventricle. (Level of Difficulty: Intermediate.).
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Affiliation(s)
- Achala Donuru
- Department of Radiology, Thomas Jefferson University Hospitals, Philadelphia, Pennsylvania, USA
- Address for correspondence: Dr. Achala Donuru, Department of Radiology, Thomas Jefferson University Hospitals, 132 S. 10th Street, 1079 Main Building, Philadelphia, Pennsylvania 19107, USA.
| | - David Saul
- Department of Medical Imaging, A.I. DuPont Hospital for Children, Wilmington, Delaware, USA
| | - Maansi Parekh
- Department of Radiology, Thomas Jefferson University Hospitals, Philadelphia, Pennsylvania, USA
| | - Maruti Kumaran
- Department of Radiology, Temple University, Philadelphia, Pennsylvania, USA
| | - Vinay Kandula
- Department of Medical Imaging, A.I. DuPont Hospital for Children, Wilmington, Delaware, USA
| | - Rami Kharouf
- Department of Cardiology, A.I. DuPont Hospital for Children, Wilmington, Delaware, USA
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8
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Prasad K, Gupta H, Sihag BK, Bootla D, Panda P, Sharma A, Chauhan R, Gawalkar A, Dahiya N. Submitral aneurysm of varied aetiologies: a case series. EUROPEAN HEART JOURNAL-CASE REPORTS 2021; 5:ytab066. [PMID: 33738423 PMCID: PMC7954274 DOI: 10.1093/ehjcr/ytab066] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Revised: 09/07/2020] [Accepted: 01/27/2021] [Indexed: 11/14/2022]
Abstract
Background Submitral aneurysm is a rare disease initially described in the African population. It is usually considered congenital in origin, due to a defect in the posterior portion of the mitral annulus. However, it can be seen in other diseases like ischaemic heart disease, rheumatic heart disease, infective endocarditis, tuberculosis, and syphilis. Case presentation Case 1 was a 29-year-old female, hypertensive undergoing maintenance haemodialysis for chronic kidney disease and on anti-tubercular therapy. She was found to have a large submitral aneurysm with severe mitral regurgitation, moderate left ventricular dysfunction, and pericardial effusion on echocardiogram. Case 2 was a 58-year-old gentleman presented with inferior wall ST-elevation myocardial infarction and was thrombolyzed with streptokinase for the same. Echocardiogram done 6 months later for evaluation of dyspnoea showed a large inferobasal aneurysm. Case 3 was a 56-year-old hypertensive presented with dyspnoea on exertion and echocardiogram showed a large posterolateral region with transmural late gadolinium enhancement. Case 4 was a 13-year-old boy presented with fever and cerebrovascular accident. Echocardiogram revealed vegetation in the mitral valve and a small submitral aneurysm with vegetation inside it. Discussion Submitral aneurysm is usually considered congenital in origin. However, it can be due to ischaemic heart disease, rheumatic heart disease, Takayasu arteritis, and tuberculosis. Top dimensional echocardiogram is the investigation of choice. Cardiac magentic resonance imaging helps in identifying the underlying aetiology and delineating the surrounding structures.
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Affiliation(s)
- Krishna Prasad
- Department of Cardiology, Post Graduate Institute of Medical Education and Research, Sector 12, 160012, Chandigarh, India
| | - Himanshu Gupta
- Department of Cardiology, Post Graduate Institute of Medical Education and Research, Sector 12, 160012, Chandigarh, India
| | - Bhupendra Kumar Sihag
- Department of Cardiology, Post Graduate Institute of Medical Education and Research, Sector 12, 160012, Chandigarh, India
| | - Dinakar Bootla
- Department of Cardiology, Post Graduate Institute of Medical Education and Research, Sector 12, 160012, Chandigarh, India
| | - Prashant Panda
- Department of Cardiology, Post Graduate Institute of Medical Education and Research, Sector 12, 160012, Chandigarh, India
| | - Arun Sharma
- Department of Radiodiagnosis and Imaging, Post Graduate Institute of Medical Education and Research, Sector 12, 160012, Chandigarh, India
| | - Rajeev Chauhan
- Department of Cardiology, Post Graduate Institute of Medical Education and Research, Sector 12, 160012, Chandigarh, India
| | - Atit Gawalkar
- Department of Cardiology, Post Graduate Institute of Medical Education and Research, Sector 12, 160012, Chandigarh, India
| | - Neelam Dahiya
- Department of Cardiology, Post Graduate Institute of Medical Education and Research, Sector 12, 160012, Chandigarh, India
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9
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Patel AJ, Mohamed S, Iqbal Y, Kar A, Soppa G. A combined approach to correct posterior left ventricular aneurysm, aortic stenosis and coronary artery disease. J Surg Case Rep 2020; 2020:rjaa356. [PMID: 33072255 PMCID: PMC7550209 DOI: 10.1093/jscr/rjaa356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Revised: 08/04/2020] [Accepted: 08/07/2020] [Indexed: 11/13/2022] Open
Abstract
Ischaemic heart disease and aortic stenosis are potentially life-threatening conditions. A post-infarct left ventricular aneurysm, when combined with the above, is particularly hazardous. We present a case where all three conditions occurred simultaneously and describe the surgical approach undertaken to attempt correction. The patient underwent aneurysmectomy together with aortic valve replacement and two-vessel coronary artery bypass grafting. The aneurysm was excised with direct linear closure of the walls using a Teflon-buttressed interrupted mattress suture technique. Post-operatively, ventricular systolic function was good (LVEF 40%) together with a well-seated aortic valve showing no paravalvular leaks. This case highlights the importance of meticulous removal of thrombus from the aneurysm and everting the edges thereby eliminating a thrombogenic surface and the risk of embolic stroke. The restorative procedure itself serves to underline the importance of ventricular shape in the effective functioning of the myocardium for sustaining an adequate stroke volume with normalized physiology.
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Affiliation(s)
- Akshay J Patel
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, B15 2TT, UK
| | - Saifullah Mohamed
- Department of Cardiothoracic Surgery, Royal Stoke University Hospital, Stoke-On-Trent, UK
| | - Yassir Iqbal
- Department of Cardiothoracic Surgery, Queen Elizabeth Hospital, Birmingham, UK
| | - Ashok Kar
- Department of Cardiothoracic Surgery, Atkinson Morley Wing, St. George's Hospital, London, UK
| | - Gopal Soppa
- Department of Cardiothoracic Surgery, Bart's Heart Centre, Bart's Health NHS Trust, London, UK
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10
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Li W. Biomechanics of infarcted left ventricle: a review of modelling. Biomed Eng Lett 2020; 10:387-417. [PMID: 32864174 DOI: 10.1007/s13534-020-00159-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2020] [Revised: 05/06/2020] [Accepted: 05/26/2020] [Indexed: 11/26/2022] Open
Abstract
Mathematical modelling in biomechanics of infarcted left ventricle (LV) serves as an indispensable tool for remodelling mechanism exploration, LV biomechanical property estimation and therapy assessment after myocardial infarction (MI). However, a review of mathematical modelling after MI has not been seen in the literature so far. In the paper, a systematic review of mathematical models in biomechanics of infarcted LV was established. The models include comprehensive cardiovascular system model, essential LV pressure-volume and stress-stretch models, constitutive laws for passive myocardium and scars, tension models for active myocardium, collagen fibre orientation optimization models, fibroblast and collagen fibre growth/degradation models and integrated growth-electro-mechanical model after MI. The primary idea, unique characteristics and key equations of each model were identified and extracted. Discussions on the models were provided and followed research issues on them were addressed. Considerable improvements in the cardiovascular system model, LV aneurysm model, coupled agent-based models and integrated electro-mechanical-growth LV model are encouraged. Substantial attention should be paid to new constitutive laws with respect to stress-stretch curve and strain energy function for infarcted passive myocardium, collagen fibre orientation optimization in scar, cardiac rupture and tissue damage and viscoelastic effect post-MI in the future.
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Affiliation(s)
- Wenguang Li
- School of Engineering, University of Glasgow, Glasgow, G12 8QQ UK
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11
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Zhang Z, Guo J. Predictive risk factors of early onset left ventricular aneurysm formation in patients with acute ST-elevation myocardial infarction. Heart Lung 2019; 49:80-85. [PMID: 31530429 DOI: 10.1016/j.hrtlng.2019.09.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Revised: 09/05/2019] [Accepted: 09/05/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND Left ventricular aneurysm (LVA) is a severe complication of ST-elevation myocardial infarction (STEMI) and is associated with poor prognosis due to high mortality. However, predictors of LVA formation in early period are inadequately defined. OBJECTIVES The purpose of this study is to determine potential predictors of LVA formation in early period (<15 days after admission) after acute STEMI. METHODS The present study was retrospectively conducted involving 1823 STEMI patients based on the AMI database of our clinic between January 2013 and April 2019. Among STEMI patients with regional wall motion abnormality (RWMA), the baseline, angiographic, procedural characteristics of patients with early-onset LVA and controls without LVA were compared. The controls were matched 2:1 with LVA cases for the admission date. Patients with prior myocardial infarction, non-ischemic cardiomyopathy, severe heart valve disease, and patients without coronary angiography were excluded. The odds ratio (OR) and confidence interval (CI) were obtained by logistic regression analysis and all statistical analysis were performed by SPSS 25.0. RESULTS Among 1823 STEMI patients who underwent coronary angiography, 103 eligible patients (median age 67 years) had LVA and were compared to 206 patients without LVA (median age 60 years). In multivariate analysis, RWMA in the left ventricular anterior wall (OR 13.17, 95%CI 2.21-78.57, p=0.005) was found to be the most striking predictor of LVA, followed by RWMA in the apex (OR 7.93, 95%CI 2.22-28.30, p=0.001). Female sex (OR 3.91, 95%CI 1.54-9.93, p=0.004), peak N-terminal pro brain natriuretic peptide (NT-pro BNP,OR 1.08, 95%CI 1.01-1.16, p=0.031), time between onset of pain and balloon time (OR 1.01, 95%CI 1.00-1.01, P=0.016), and presence of QS-waves on initial electrocardiogram (OR 3.06, 95%CI 1.49-6.27, P=0.016) were independently associated with LVA formation. CONCLUSION This study indicated that female sex, peak NT-pro BNP, the time between the onset of pain and balloon time, presence of QS-waves on initial electrocardiogram, RWMA of left ventricular anterior wall and apex were the independent predictors of early-onset LVA in patients with acute STEMI.
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Affiliation(s)
- Zenghui Zhang
- Department of Cardiology, the First Affiliated Hospital of Jinan University, Guangzhou 510630, China
| | - Jun Guo
- Department of Cardiology, the First Affiliated Hospital of Jinan University, Guangzhou 510630, China.
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12
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Kanabar K, Prasad K, Rani P, Kaur N, Santosh K, Mehrotra S. Large infero-basal left ventricular aneurysm with organized thrombus. J Echocardiogr 2019; 18:262-264. [PMID: 31367832 DOI: 10.1007/s12574-019-00437-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2019] [Revised: 07/18/2019] [Accepted: 07/20/2019] [Indexed: 11/30/2022]
Affiliation(s)
- Kewal Kanabar
- Department of Cardiology, Postgraduate Institute of Medical Education and Research (PGIMER), 3rd Floor, C Block, Faculty Room, ACC, Sector 12, Chandigarh, 160012, India
| | - Krishna Prasad
- Department of Cardiology, Postgraduate Institute of Medical Education and Research (PGIMER), 3rd Floor, C Block, Faculty Room, ACC, Sector 12, Chandigarh, 160012, India
| | - Prithvi Rani
- Department of Radiodiagnosis, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, 160012, India
| | - Navjyot Kaur
- Department of Cardiology, Postgraduate Institute of Medical Education and Research (PGIMER), 3rd Floor, C Block, Faculty Room, ACC, Sector 12, Chandigarh, 160012, India
| | - Krishna Santosh
- Department of Cardiology, Postgraduate Institute of Medical Education and Research (PGIMER), 3rd Floor, C Block, Faculty Room, ACC, Sector 12, Chandigarh, 160012, India
| | - Saurabh Mehrotra
- Department of Cardiology, Postgraduate Institute of Medical Education and Research (PGIMER), 3rd Floor, C Block, Faculty Room, ACC, Sector 12, Chandigarh, 160012, India.
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13
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Babb DE, Vera-Arroyo A, Rodriquez-Blanco Y, Fabbro M. An Unusual Suspect in a Case of Left Ventricular Aneurysm. J Cardiothorac Vasc Anesth 2019; 33:2344-2348. [PMID: 30709593 DOI: 10.1053/j.jvca.2019.01.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2018] [Indexed: 11/11/2022]
Abstract
True left ventricular aneurysms are most frequently seen after acute transmural myocardial infarction. These aneurysms are distinct from apical left ventricular pseudoaneurysms, which can also be seen in ischemia, and have a different treatment course. A major dilemma for clinicians is using echocardiographic information to make this distinction. Coronary angiography aids in this distinction; however, in the case of normal coronaries alternate etiologies must be considered. The differential for a patient with a left ventricular aneurysm and normal coronaries or no prior cardiac surgery is broad and includes traumatic, infectious and infiltrative causes. In this e-challenge, we present an unusual cause of a left ventricular apical aneurysm in a patient with normal coronary arteries residing in the United States.
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Affiliation(s)
- Danielle E Babb
- Jackson Memorial Hospital, University of Miami Miller School of Medicine, Miami, FL.
| | - Arnaldo Vera-Arroyo
- Jackson Memorial Hospital, University of Miami Miller School of Medicine, Miami, FL; Miami Veteran's Health Administration, Miami, FL
| | | | - Michael Fabbro
- Jackson Memorial Hospital, University of Miami Miller School of Medicine, Miami, FL
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14
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Ola O, Dumancas C, Mene-Afejuku TO, Akinlonu A, Al-Juboori M, Visco F, Mushiyev S, Pekler G. Left Ventricular Aneurysm May Not Manifest as Persistent ST Elevation on Electrocardiogram. Am J Case Rep 2017; 18:410-413. [PMID: 28412760 PMCID: PMC5402854 DOI: 10.12659/ajcr.902884] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Patient: Male, 67 Final Diagnosis: Left Ventricular aneurysm post myocardial infarction Symptoms: Chest pain Medication: Dual antiplatelet therapy • anticoagulation Clinical Procedure: Cardiac catheterization Specialty: Cardiology
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Affiliation(s)
- Olatunde Ola
- Department of Medicine, New York Medical College, Metropolitan Hospital Center, New York, NY, USA
| | - Carissa Dumancas
- Department of Medicine, New York Medical College, Metropolitan Hospital Center, New York, NY, USA
| | | | - Adedoyin Akinlonu
- Department of Medicine, New York Medical College, Metropolitan Hospital Center, New York, NY, USA
| | - Mohammed Al-Juboori
- Department of Medicine, New York Medical College, Metropolitan Hospital Center, New York, NY, USA
| | - Ferdinand Visco
- Division of Cardiology, New York Medical College, Metropolitan Hospital Center, New York, NY, USA
| | - Savi Mushiyev
- Division of Cardiology, New York Medical College, Metropolitan Hospital Center, New York, NY, USA
| | - Gerald Pekler
- Division of Cardiology, New York Medical College, Metropolitan Hospital Center, New York, NY, USA
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Abstract
3D-printed models fabricated from CT, MRI, or echocardiography data provide the advantage of haptic feedback, direct manipulation, and enhanced understanding of cardiovascular anatomy and underlying pathologies. Reported applications of cardiovascular 3D printing span from diagnostic assistance and optimization of management algorithms in complex cardiovascular diseases, to planning and simulating surgical and interventional procedures. The technology has been used in practically the entire range of structural, valvular, and congenital heart diseases, and the added-value of 3D printing is established. Patient-specific implants and custom-made devices can be designed, produced, and tested, thus opening new horizons in personalized patient care and cardiovascular research. Physicians and trainees can better elucidate anatomical abnormalities with the use of 3D-printed models, and communication with patients is markedly improved. Cardiovascular 3D bioprinting and molecular 3D printing, although currently not translated into clinical practice, hold revolutionary potential. 3D printing is expected to have a broad influence in cardiovascular care, and will prove pivotal for the future generation of cardiovascular imagers and care providers. In this Review, we summarize the cardiovascular 3D printing workflow, from image acquisition to the generation of a hand-held model, and discuss the cardiovascular applications and the current status and future perspectives of cardiovascular 3D printing.
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16
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Multiple left ventricular aneurysms in a young female. Rev Port Cardiol 2016; 35:113.e1-6. [PMID: 26852308 DOI: 10.1016/j.repc.2015.09.020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2014] [Revised: 07/18/2015] [Accepted: 09/02/2015] [Indexed: 11/22/2022] Open
Abstract
Multiple left ventricular aneurysms (LVAs) are rare, especially in a young female. A 29-year-old woman presented vague symptoms. Multiple LVAs were revealed and confirmed on different imaging modalities, including chest radiography, echocardiography, contrast ventriculography and cardiac magnetic resonance imaging. Detailed work-up for probable etiologies including ischemic, infectious, inflammatory and autoimmune causes was negative. In the absence of angina, decompensated congestive heart failure, arrhythmias and embolism, the patient was managed conservatively, with excellent mid-term outcome.
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17
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Multiple left ventricular aneurysms in a young female. REVISTA PORTUGUESA DE CARDIOLOGIA (ENGLISH EDITION) 2016. [DOI: 10.1016/j.repce.2016.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Leucker TM, Agrawal V, Rahim H, Price J, Jones SR. Idiopathic 'True' Left Ventricular Aneurysm. J Cardiol Cases 2015; 12:202-204. [PMID: 26664501 DOI: 10.1016/j.jccase.2015.08.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
We report the case of a 67-year-old patient who presented with anginal symptoms to the hospital. Computed tomographic angiography, to rule out a pulmonary embolism, showed a left ventricular apical outpouching. The patient underwent further imaging modalities, including contrast echocardiography (TTE) and cardiovascular magnetic resonance imaging (CMR), which were suggestive of a true left ventricular aneurysm (LVA). The absence of obstructive coronary artery disease on coronary angiography, absence of late enhancement on the CMR, and ultimately the intraoperative findings during surgical resection of the aneurysm, were strong indicators of a non-ischemic etiology of the patient's LVA. Additionally, the patient denied any previous history of cardiac instrumentation to rule out iatrogenic causes of LVA and congenital causes were excluded by a previous echocardiogram. Finally, history and presenting electrocardiogram did not reveal any other underlying obvious causes for the LVA. Excluding all common causes for the LVA an idiopathic cause seemed most likely.
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Affiliation(s)
- Thorsten M Leucker
- Department of Medicine, Division of Cardiology, Johns Hopkins University, Baltimore, MD, USA
| | - Vineet Agrawal
- Department of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Hussein Rahim
- Department of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Joel Price
- Department of Surgery, Division of Cardiac Surgery, Johns Hopkins University, Baltimore, MD, USA
| | - Steven R Jones
- Department of Medicine, Division of Cardiology, Johns Hopkins University, Baltimore, MD, USA
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Left Ventricular Aneurysm Presenting as a Late Complication of Childhood Chemotherapy. Case Rep Cardiol 2015; 2015:625451. [PMID: 26448882 PMCID: PMC4581496 DOI: 10.1155/2015/625451] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2015] [Accepted: 08/27/2015] [Indexed: 12/27/2022] Open
Abstract
Cardiotoxicity is a well known adverse effect of chemotherapy. Multiple cardiac injuries have been reported including cardiomyopathy, pericarditis, myocarditis, angina, arrhythmias, and myocardial infarction. A left ventricular aneurysm due to chemotherapy is
a rare and a dangerous complication which is particularly challenging in diagnosis requiring a high index of suspicion and periodic imaging. We present a case of a young Caucasian male with a past medical history of Acute Lymphocytic Leukemia status after chemotherapy during his childhood diagnosed with left ventricular aneurysm several years later.
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Abstract
Cardiac aneurysm occurring in ventricles is usually a complication of acute transmural myocardial infarction. The development of cardiac aneurysm represents a process of continued thinning and fibrosis of the necrotic tissue of the ventricular wall. Survival of the person without any complication depends on the development of the solid fibrous scar, which seals the aneurysmal cavity.We present an incidental case wherein a person survived with a ventricular aneurysm that sealed itself by natural means due to the development of a thrombus and fibrous tissue offering a natural protection. The person died because of head injury in a road traffic accident in this particular case.
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Tikiz H, Balbay Y, Atak R, Terzi T, Genç Y, Kütük E. The effect of thrombolytic therapy on left ventricular aneurysm formation in acute myocardial infarction: relationship to successful reperfusion and vessel patency. Clin Cardiol 2009; 24:656-62. [PMID: 11594411 PMCID: PMC6654946 DOI: 10.1002/clc.4960241005] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Although there is increasing evidence for the beneficial effect of thrombolytic therapy on global left ventricular (LV) function in acute myocardial infarction (AMI), the data concerning the early effect of thrombolytic therapy on the incidence of left ventricular aneurysm (LVA) formation and its relationship to clinical and angiographic determinants are limited. HYPOTHESIS The study aimed to determine the independent factors involved in the development of LVA and to evaluate whether thrombolytic therapy has any preventive effect on the development of LVA in AMI. METHODS In all, 350 consecutive patients suffering from a first attack of AMI were included. Of these, 205 who arrived within 12 h of onset of symptoms received thrombolytic therapy (thrombolytic group) and the remaining 145 patients served as control group. All patients received aspirin and maximal-dose anticoagulation with intravenous heparin therapy. Early successful reperfusion was assessed by enzymatic and electrocardiographic evidence, and late vessel patency was evaluated according to Thrombolysis in Myocardial Infarction (TIMI) classification. Patients with TIMI grade 2 or 3 flow were considered to have vessel patency. RESULTS The overall incidence of LVA was 11.7% (41/350), and no statistical difference was found between the incidence of LVA between the two groups (11.7 vs. 11.7%, p>0.05). However, the patients receiving thrombolytic therapy and exhibiting a patent infarct-related artery (PIRA) (n = 125, 61%), had a significantly reduced incidence of LVA compared with those who did not (7.2 vs. 18.8%, p= 0.015). In univariate analysis, vessel patency, proximal left anterior descending artery (LAD) stenosis, total LAD occlusion, multivessel disease, and hypertension were found to be important factors in LVA formation after AMI. After adjustment for other clinical and angiographic variables, total LAD occlusion (odds ratio [OR] 3.62,95% confidence interval [CI] 2.45-8.42, p = 0.0014), absence of PIRA (OR 2.92, 95% CI 1.41-09, p = 0.0037) and proximal LAD stenosis (OR 2.11, 95% CI 1.05-4.71, p = 0.045) remained the independent determinants of LVA formation after AMI. CONCLUSION Our data indicate that not all patients who received thrombolytic therapy, but only those with PIRA had evidently reduced the incidence of LVA. Patients with total LAD occlusion, with proximal LAD stenosis, and without PIRA were found to have increased risk for formation of LVA after AMI. These findings indicate that the presence of vessel patency has a preventive effect on LVA formation in AMI.
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Affiliation(s)
- H Tikiz
- Türkiye Yüksek Ihtisas Hospital, Department of Cardiology, Ankara, Turkey.
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23
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Chaubal N, Dighe M, Shah M, Chaubal J, Raghavan J. Congenital left ventricular aneurysm: prenatal sonographic diagnosis. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2004; 23:125-128. [PMID: 14756360 DOI: 10.7863/jum.2004.23.1.125] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
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Tikiz H, Atak R, Balbay Y, Genç Y, Kütük E. Left ventricular aneurysm formation after anterior myocardial infarction: clinical and angiographic determinants in 809 patients. Int J Cardiol 2002; 82:7-14; discussion 14-6. [PMID: 11786151 DOI: 10.1016/s0167-5273(01)00598-8] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Previous studies have reported controversial results regarding the clinical and angiographic factors involved in the left ventricular aneurysm (LVA) formation after myocardial infarction (MI). OBJECTIVE This study was performed to determine the clinical and angiographic factors that are priori predictors of LVA following anterior myocardial infarction and so to provide a paradigm which may identify patients who were candidates for aneurysm formation. METHODS Of the patients who underwent coronary angiography during the interval between 1995 and 2000 in our clinic, 809 were found to have anterior MI and LVA (aneurysm group) (677 men, 132 women, mean age 53.3+/-11.4 years). The clinical and the angiographic data of these patients were compared with those of 446 patients (399 men, 47 women, mean age 55.2+/-10.5 years) with previous anterior MI and without LVA (control group). RESULTS LVA was found to occur more frequently in females (16.3% in women and 10.4%, in men, P=0.03) and in patients without previous angina (23.5 vs. 8.2%, P<0.0001). Major cardiovascular risk factors, previous anti-anginal medication and thrombolytic therapy did not show a significant difference between the two groups. Angiographic examination revealed that single-vessel disease, proximal left anterior descending artery (LAD) stenosis, total LAD occlusion, mean stenosis in LAD artery, end-diastolic pressure and left ventricular score were all higher in the aneurysm group compared to control group. After adjustment for other clinical and angiographic variables, single-vessel disease [odds ratio (OR) 5.89, 95% confidence interval (CI)=3.68-9.28, P<0.0001), absence of previous angina (OR=4.21, 95% CI=2.1-7.48, P=0.0003), total LAD occlusion (OR=2.63, 95% CI=1.97-3.53, P<0.0017) and female gender (OR=1.60, 95% CI=1.20-2.28, P=0.043) remained the independent determinants of LVA formation after anterior MI. CONCLUSION In patients with LVA, logistic regression analysis revealed that (1) single-vessel disease, (2) absence of previous angina, (3) total LAD occlusion and (4) female gender were independent determinants in the formation of LVA after anterior MI. Coronary collateral status and risk factors, such as hypertension, diabetes mellitus, hypercholesterolemia, smoking and family history of CAD were not found to be important determinants in the aneurysm formation.
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Affiliation(s)
- Hakan Tikiz
- University of Celal Bayar, Department of Cardiology, Manisa, Turkey.
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Debray M, Pautas E, Dulou L, Laurent M, Le Blanche AF. Aneurysm of the left ventricle: a two-decade silent history. J Am Geriatr Soc 2001; 49:337-8. [PMID: 11300250 DOI: 10.1046/j.1532-5415.2001.49303345.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Rademaker MT, Cameron VA, Charles CJ, Espiner EA, Nicholls MG, Pemberton CJ, Richards AM. Neurohormones in an ovine model of compensated postinfarction left ventricular dysfunction. Am J Physiol Heart Circ Physiol 2000; 278:H731-40. [PMID: 10710340 DOI: 10.1152/ajpheart.2000.278.3.h731] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Clinical heart failure, often the result of myocardial infarction, may be preceded by a period of compensated left ventricular impairment. There is substantial need for an experimental model that reflects this human condition. In sheep, coronary artery ligation produced consistent left ventricular anteroapical myocardial infarctions resulting in chronic (5 wk), stable hemodynamic changes compared with sham controls, including reductions in ejection fraction (51 +/- 2 vs. 30 +/- 5%, P < 0.001), cardiac output (6.3 +/- 0.2 vs. 5.1 +/- 0.2 l/min, P < 0.01), and arterial pressure (93 +/- 2 vs. 79 +/- 3 mmHg, P < 0.001), and increases in cardiac preload (left atrial pressure, 3.3 +/- 0.1 vs. 8.3 +/- 1.3 mmHg, P < 0.001). These changes were associated with acute and sustained increases in plasma concentrations of atrial natriuretic peptide (ANP; 5 wk, 11 +/- 2 vs. 27 +/- 5 pmol/l, P < 0.001), brain natriuretic peptide (BNP; 3 +/- 0.2 vs. 11 +/- 2 pmol/l, P < 0.001), and amino-terminal pro-brain natriuretic peptide (NT-BNP; 17 +/- 3 vs. 42 +/- 12 pmol/l, P < 0.001). Significant correlations were observed between plasma levels of the natriuretic peptides (ANP, day 7 to week 5 samples; BNP and NT-BNP, day 1 to week 5 samples) and changes in left ventricular volumes and ejection fraction. In contrast, renin activity, aldosterone, catecholamines, and endothelin were not chronically elevated postinfarction and were not related to indexes of ventricular function. Coronary artery ligation in sheep produces the pathological, hemodynamic, and neurohormonal characteristics of compensated left ventricular impairment secondary to myocardial infarction. Plasma concentrations of the cardiac natriuretic peptides are sensitive markers of left ventricular dysfunction. This is a reproducible model that reflects the clinical condition and should prove suitable for investigating the pathophysiology of, and experimental therapies in, early left ventricular dysfunction.
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Affiliation(s)
- M T Rademaker
- Cardioendocrine Research Group, Department of Medicine, The Christchurch School of Medicine, Christchurch, New Zealand.
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27
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Eid HE. Role of Intraaortic Balloon Pump in Left Ventricular Endoaneurysmorrhaphy. Asian Cardiovasc Thorac Ann 1999. [DOI: 10.1177/021849239900700406] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Intraaortic balloon counterpulsation has become a prerequisite for surgical repair of a left ventricular aneurysm. From October 1991 to October 1996, 60 consecutive patients underwent left ventricular endoaneurysmorrhaphy. Most had associated procedures, mainly coronary artery bypass grafting. Twenty-two patients (36.7%) were in New York Heart Association functional class III or IV preoperatively. These included 16 (26.7%) who had low cardiac output requiring an intraaortic balloon pump in the perioperative period. Pharmacological inotropic support alone was inadequate in 13 of these patients, one required a balloon pump for 5 days preoperatively due to severe low cardiac output, and 2 needed mechanical support postoperatively for ventricular arrhythmia and low cardiac output. The other 44 patients (73.3%) recovered without mechanical support. This study highlights the important role of intraaortic balloon counterpulsation in the surgical treatment of postinfarction left ventricular aneurysm.
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Affiliation(s)
- Hossam Eldin Eid
- Department of Cardiothoracic Surgery, Texas Heart Institute, Houston, Texas, USA, Ain Shams University Hospitals, Cairo, Egypt, Dubai Hospital, Dubai, UAE
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28
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Dubel HP, Rutsch W, Bohm J, Vohringer HF. Huge false aneurysm of left ventricular posterior wall following resection of an aneurysm of the left ventricular posterior wall. Catheter Cardiovasc Interv 1999; 46:509-10. [PMID: 10216027 DOI: 10.1002/(sici)1522-726x(199904)46:4<509::aid-ccd27>3.0.co;2-s] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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29
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Coene Bales A, Sandelski J, Sareli P, Lang RM. Left Ventricular Diverticula and Aneurysms: Congenital and Acquired Lesions. Echocardiography 1998; 15:77-88. [PMID: 11175014 DOI: 10.1111/j.1540-8175.1998.tb00581.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Congenital diverticula and aneurysms are extremely rare cardiac anomalies, in contrast to acquired ventricular outpouchings, which are relatively commonplace. The English language literature pertaining to congenital lesions in particular is somewhat sparse; in addition, a definitive classification scheme for these malformations is lacking. In this manuscript, we review the salient literature pertaining to congenital diverticula, congenital aneurysms, acquired true aneurysms, "aneurysms" of the membranous interventricular septum, and left ventricular pseudoaneurysms. This is performed with attention to the clinical and pathological characteristics, etiology (if known), prognosis, and suggested management of these lesions. Important echocardiographic features are delineated in the figure legends; however, the differentiation between these lesions often must be made on clinical grounds as well.
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Affiliation(s)
- Amy Coene Bales
- The University of Chicago Hospitals, M.C. 5084, 5841 S. Maryland Ave., Chicago, IL 60637
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30
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Hadland H, Merzkirch W, Blümchen G, Kottmann W. [Experimental simulation of dyskinetic heart wall aneurysms]. BIOMED ENG-BIOMED TE 1996; 41:190-5. [PMID: 8963020 DOI: 10.1515/bmte.1996.41.7-8.190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
A mechanical model for the quantitative investigation of the loss of performance of a ventricle caused by aneurysms of different sizes is described. The model permits an accurate simulation of the geometry of both the ventricle and the aneurysm, as well as the mechanical flow situation as expressed by the changing pattern of the intraventricular pressure. Investigations are limited to a determination of the loss of ventricular performance brought about by the dyskinetic motion of the aneurysm.
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Affiliation(s)
- H Hadland
- Lehrstuhl für Strömungslehre, Universität Essen
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31
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Abstract
Ventricular aneurysms are circumscribed, thin-walled fibrous, noncontractile outpouchings of the ventricle. The majority are apically located, true aneurysms of the left ventricle (LV) that occur as a consequence of transmural myocardial infarction (MI). The precursor of aneurysm formation appears to be infarct expansion early after acute MI and occurrence generally relates to infarct size. The presence of underlying hypertension and the use of steroids and nonsteroidal antiinflammatory agents may promote aneurysm formation. The clinical sequelae include congestive heart failure (CHF), thromboembolism, angina pectoris, and ventricular tachyarrhythmias. Late rupture is a particular complication of false aneurysms in which the pericardium is the aneurysm wall. The diagnosis may be suspected by the clinical finding of a diffuse, pansystolic apical thrust, persistent ST-segment elevation on the electrocardiogram, and distortion of the cardiac silhouette on chest x-ray. This can be confirmed using echocardiography, radionuclide ventriculography, and cardiac catheterization. The latter has the additional advantage of being able to delineate the coronary anatomy. Management involves prevention, specific therapy for the various clinical manifestations, and surgery. Therapeutic interventions with thrombolytic agents, aspirin, heparin, and beta blockers that are applied early in the evolution of an MI may limit infarction size, thereby reducing the tendency toward infarct expansion and aneurysm formation. Patients with mild CHF can usually be controlled with the standard combination of angiotensin-converting enzyme inhibitors, diuretics, and digoxin. Thromboembolism is best prevented by anticoagulation with warfarin for at least 3 months after the acute MI. The choice of pharmacotherapy for ventricular tachyarrhythmias should be guided by electrophysiologic studies. The treatment of patients with angina pectoris utilizes conventional therapeutic modalities.(ABSTRACT TRUNCATED AT 250 WORDS)
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Affiliation(s)
- B M Friedman
- Department of Internal Medicine, University of Kansas Medical Center, Kansas City 66160-7378, USA
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32
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Abstract
Acute myocardial infarction is difficult enough to manage without the complications that commonly occur in the first days and weeks that follow. This article covers the most frequent complications, outlining when they are likely to occur, what the symptoms are, how they are best treated, and what sort of prognosis can be expected. In this way, the author provides a "map" of the days after infarction, showing the pitfalls and sand traps of clinical management.
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Affiliation(s)
- P N Subramaniam
- Department of Medicine, Louisiana State University School of Medicine, New Orleans
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Partanen J, Kupari M, Heikkilä J, Keto P. Left ventricular aneurysm associated with apical hypertrophic cardiomyopathy. Clin Cardiol 1991; 14:936-9. [PMID: 1764832 DOI: 10.1002/clc.4960141115] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
A 47-year-old man with apical hypertrophic cardiomyopathy and an apical left ventricular aneurysm with palpitation as the initial manifestation is described. There was no intraventricular pressure gradient. The aneurysm is suggested to be a part of the myocardial disease or to be caused by myocardial bridging of the left anterior descending coronary artery demonstrated by angiography. The 24-hour ambulatory ECG recording showed only isolated ventricular ectopic beats and the clinical course has been favorable during 20 months without therapy.
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Affiliation(s)
- J Partanen
- First Department of Medicine, University Central Hospital, Helsinki, Finland
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Markovitz LJ, Savage EB, Ratcliffe MB, Bavaria JE, Kreiner G, Iozzo RV, Hargrove WC, Bogen DK, Edmunds LH. Large animal model of left ventricular aneurysm. Ann Thorac Surg 1989; 48:838-45. [PMID: 2596920 DOI: 10.1016/0003-4975(89)90682-6] [Citation(s) in RCA: 139] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
In 28 Dorsett sheep, ligation of the distal homonymous (equivalent to human left anterior descending) and second diagonal coronary arteries produced a constant transmural infarct of 22.9% +/- 2.5% (mean +/- standard deviation) of the left ventricular mass. Serial left ventriculograms showed that within four hours the infarct segment expands, wall thickness decreases, and aneurysmal dilatation occurs and progresses over the next 60 days in all sheep. Epicardial ventricular point references indicated that adjacent noninfarcted myocardium participates in the formation of the aneurysm. Anatomy of the coronary vasculature was studied in 22 excised sheep hearts. In sheep, coronary arterial anatomy is remarkably constant. The left coronary artery provides all of the blood supply to the left ventricle and septum and only a small rim of both the anterior and posterior right ventricles. Cardiac veins from the left ventricle drain into the coronary sinus, which also receives the left azygos vein. Right ventricular veins drain separately. The essentially separate coronary circulations to the two ventricles, the paucity of coronary collateral circulation, and the consistent evolution of left ventricular infarcts into aneurysms are important advantages of the ovine model for both metabolic and ventricular mechanical studies of acute myocardial infarction and left ventricular aneurysm.
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Affiliation(s)
- L J Markovitz
- Department of Surgery, University of Pennsylvania, Philadelphia 19104
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