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Torchio F, Garatti A, Ronco D, Matteucci M, Massimi G, Lorusso R. Left ventricular pseudoaneurysm: the niche of post-infarction mechanical complications. Ann Cardiothorac Surg 2022; 11:290-298. [PMID: 35733717 PMCID: PMC9207692 DOI: 10.21037/acs-2022-ami-25] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Accepted: 03/22/2022] [Indexed: 09/02/2024]
Abstract
Left ventricular pseudoaneurysm (LVP) is a very rare, but potentially lethal mechanical complication of acute myocardial infarction (AMI). Despite representing a unique subset of cardiac rupture, it presents peculiar features that distinguish it from both ventricular free-wall rupture (FWR) and ventricular true aneurysm. LVP occurs in less than 0.5% of patients affected by AMI. However, LVP is generally burdened by high mortality, often related to false cavity rupture, leading to catastrophic and often irreversible consequences. The risk of rupture is inversely proportional to the timing from AMI onset, which also determines both the classification of LVP and drives the indication for treatment. Despite the lack of a current consensus on LVP management, urgent surgery is the treatment of choice for LVPs occurring within 3 months from AMI, especially if larger than 3 cm in diameter. A matter of debate, however, is represented by chronic LVPs, especially because the risk of rupture decreases progressively as time passes and left ventricular (LV) false cavity stabilizes. Surgical mortality rate remains not negligible (more than 20%), but these suboptimal results may be considered acceptable, especially considering the lethality associated with the occurrence of pseudoaneurysm rupture. Diagnostic workup is essential for anatomical characterization of LV rupture, which is mandatory to guide the decision on surgical approach and technique for pseudoaneurysm repair. Finally, for a subset of patients with anterior LVP and a well-defined fibrotic neck, and deemed at excessively high surgical risk, percutaneous closure of the cavity has been described with encouraging results.
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Affiliation(s)
- Federica Torchio
- Department of Cardiothoracic Surgery, Heart and Vascular Centre, Maastricht University Medical Centre, Maastricht, The Netherlands
- Department of Medicine and Surgery, Circolo Hospital, University of Insubria, Varese, Italy
| | - Andrea Garatti
- Cardiac Surgery Unit, IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - Daniele Ronco
- Department of Cardiothoracic Surgery, Heart and Vascular Centre, Maastricht University Medical Centre, Maastricht, The Netherlands
- Department of Medicine and Surgery, Circolo Hospital, University of Insubria, Varese, Italy
| | - Matteo Matteucci
- Department of Cardiothoracic Surgery, Heart and Vascular Centre, Maastricht University Medical Centre, Maastricht, The Netherlands
- Department of Medicine and Surgery, Circolo Hospital, University of Insubria, Varese, Italy
| | - Giulio Massimi
- Department of Cardiothoracic Surgery, Heart and Vascular Centre, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Roberto Lorusso
- Department of Cardiothoracic Surgery, Heart and Vascular Centre, Maastricht University Medical Centre, Maastricht, The Netherlands
- Cardiovascular Research Institute Maastricht, Maastricht, The Netherlands
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Yu P, Xi P, Tang Y, Xu J, Liu Y. Novel Analysis of Coronary Angiography in Predicting the Formation of Ventricular Aneurysm in Patients With Acute Myocardial Infarction After Percutaneous Coronary Intervention. Front Cardiovasc Med 2022; 9:880289. [PMID: 35571192 PMCID: PMC9095940 DOI: 10.3389/fcvm.2022.880289] [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: 02/21/2022] [Accepted: 03/29/2022] [Indexed: 11/16/2022] Open
Abstract
Background Ventricular aneurysm (VA) is a serious complication of acute myocardial infarction (AMI), with a very poor prognosis. Early-stage prophylactic treatment is effective in preventing the formation of VAs. However, the existing predictive models for VA formation lack the sensitivity and specificity necessary for evaluating patients with MI. This study aimed to explore the potential use of coronary angiography and establish a more precise prediction model for VA in patients with MI. Methods Patients with VA (n = 52) admitted to our medical center between June 2020 and July 2021 with previous emergency percutaneous coronary intervention for AMI were retrospectively included in this database study. Controls that matched 4:1 with the VA cases during the same period were enrolled. The baseline characteristics and coronary angiograms of the enrolled individuals were obtained from the electronic medical record system. The curve length of the distance from the main criminal lesion to its ostia (DLO) and distal (DLD) in the coronary artery were measured with ImageJ. Binary logistic regression analysis was used to identify the predictive factors. The model performance was evaluated by receiver operating characteristic curve analysis. Results Binary analysis revealed maximum serum cardiac troponin I level (odds ratio [OR] = 1.046, 95% confidence interval [CI] = 1.027–1.066, P < 0.001), serum brain natriuretic peptide level (OR = 1.001, 95% CI = 1.000–1.002, P = 0.007), left anterior descending artery as the culprit lesion (OR = 5.091, 95% CI = 2.080–12.457, P < 0.001), and that single-vessel disease (OR = 1.809, 95% CI = 0.967–3.385, P < 0.001), stenosis in the main lesion (OR = 1.247, 95% CI = 1.173–1.327, P < 0.001), DLO (OR = 1.034, 95% CI = 1.019–1.049, P < 0.001), DLD (OR = 1.061, 95% CI = 1.043–1.079, P < 0.001), and DLD/DLD (OR = 0.033, 95% CI = 0.010–0.117, P < 0.001) were the independent variables for predicting VA formation in MI patients. Conclusion Our study first used quantified information of coronary lesions to establish a predictive model and proved that a longer DLD had the greatest potential in predicting the incidence of VA. Its related parameters including DLO and DLO/DLD ratio were also correlated with the incidence of VA. These findings may provide a new reference for the early identification of high-risk MI patients and preventing VA.
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Bhullar AS, Sandhu CS, Bhullar MS, Rathod A. Unusual presentation of left ventricular rupture. BMJ Case Rep 2020; 13:13/1/e231680. [PMID: 32014988 DOI: 10.1136/bcr-2019-231680] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
We describe a case of 49-year-old man who presented with chest pain and was diagnosed with non-ST elevation myocardial infarction. Transthoracic echocardiogram (TTE) showed severe global hypokinesis of left ventricle with ejection fraction of 25%-30%. Left heart catheterisation showed severe right coronary stenosis and focal 60%-70% distal left anterior descending artery stenosis. Cardiac MRI (CMR) was done for evaluation of viability which showed a large pseudoaneurysm which was missed on TTE and left ventriculogram. Our case demonstrates the increasing importance of cardiac MRI in the diagnosis of left ventricular pseudoaneurysm. In our case left ventricular pseudoaneurysm was missed on TTE and left ventriculogram. It was diagnosed on CMR which was ordered for evaluation of myocardium viability.
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Affiliation(s)
- Amarbir S Bhullar
- Cardiology, University of California San Francisco, Fresno, California, USA
| | | | | | - Ankit Rathod
- Cardiology, University of California San Francisco, Fresno, California, USA
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Díaz-Navarro R, Nihoyannopoulos P. Post-myocardial infarction left ventricular pseudoaneurysm diagnosed incidentally by echocardiography. Echo Res Pract 2017; 4:K37-K40. [PMID: 28986350 PMCID: PMC5633050 DOI: 10.1530/erp-17-0035] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2017] [Accepted: 09/12/2017] [Indexed: 11/24/2022] Open
Abstract
A 54-year-old male developed a left ventricular pseudoaneurysm (Ps) along the lateral wall of the left ventricle (LV), which was diagnosed incidentally by two-dimensional transthoracic echocardiography (2DTTE) 6 months after an acute myocardial infarction. Color flow imaging (CFI) showed blood flow from the LV into the aneurysmal cavity and invasive coronary angiography revealed sub-occlusion of the circumflex artery. A complementary study using cardiovascular magnetic resonance (CMR) confirmed a dilated left ventricle with depressed ejection fraction, thin dyskinetic anterolateral and inferolateral walls, a Ps adjacent to the lateral wall of the LV contained by the pericardium and blood passing in and out through a small defect in the LV mid-anterolateral wall. Late gadolinium-enhanced imaging demonstrated transmural myocardial infarction in the lateral wall and delayed enhancement of the pericardium, which formed the walls of the Ps. A conservative approach was adopted in this case, optimizing the patient’s heart failure medications, including cardioselective beta-blocker agents, angiotensin-converting enzyme inhibitors, spironolactone and chronic anticoagulation therapy because of a high risk of ischemic stroke in these patients. At the 13-month follow-up, the patient remained stable with New York Heart Association class II heart failure. In conclusion, 2DTTE and CFI seem to be suitable initial methods for diagnosing Ps of the LV, but CMR is an excellent complementary method for characterizing further this cardiac entity. Furthermore, the long-term outcome of patients with Ps of the LV who are treated medically appears to be relatively benign.
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Affiliation(s)
- Rienzi Díaz-Navarro
- Departamento de Medicina Interna, Escuela de Medicina, Universidad de Valparaíso, Valparaíso, Chile
| | - Petros Nihoyannopoulos
- Department of Cardiovascular Sciences, Hammersmith Hospital, Imperial College London, NHLI, Hammersmith Hospital, London, UK
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5
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Kajita AH, Oliveira MDP, Menezes FR, Franken M, Baraciolli LM, Nicolau JC. Giant and Calcified Post-Infarction True Left Ventricular Aneurysm: What to Do? Arq Bras Cardiol 2016; 106:259-62. [PMID: 27027370 PMCID: PMC4811282 DOI: 10.5935/abc.20150087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2015] [Accepted: 05/11/2015] [Indexed: 11/20/2022] Open
Affiliation(s)
| | | | | | - Marcelo Franken
- Instituto do Coração, Universidade de São Paulo, São Paulo, SP, Brazil
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With computed tomography confirmed anterolateral left ventricular pseudoaneurysm in patient with dilatative alcoholic cardiomyopathy. Radiol Oncol 2012; 45:180-3. [PMID: 22933953 PMCID: PMC3423740 DOI: 10.2478/v10019-011-0021-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2011] [Accepted: 03/25/2011] [Indexed: 11/20/2022] Open
Abstract
Background Pseudoaneurysms are rare complications of myocardial infarction with propensity for rupture. There is still a challenge with which diagnostic imaging we performed a final diagnosis of pseudoaneurysm and differentiate it from true aneurysm what is clinically important due to the different treatment. Case report. We presented the unusual case of a 56-year-old man with signs of decompensated heart failure which had worsened a few months before hospitalization. We believed that during worsening of symptoms the patient suffered a silent myocardial infarction complicated by subacute free wall rupture which resulted into left ventricular pseudoaneurysm formation without tamponade. Echocardiography showed dilatative cardiomyopathy which was already present years before and a very rare location of the left ventricular pseudoaneurysm on the anterolateral part of the left ventricle. Pseudoaneurysm was confirmed with CT scan. Due to the severity of contractile dysfunction and no response in treatment for congestive heart failure the directive for the resection was tempered and the patient died due to the progressive heart failure and embolic phenomena. Conclusions This report shows the importance of non-invasive imaging diagnostic evaluation of acute decompensated heart failure where echocardiography and chest X-ray are the first diagnostic steps. Based on those findings further imaging diagnostic steps must be performed such as CT scan in our case which finally confirms left ventricular pseudoaneurysm with dilatative cardiomyopathy.
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7
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Oliveira SM, Dias P, Pinho T, Gavina C, Almeida PB, Madureira AJ, Pinho P, Ramos I, Maciel MJ. Pseudoaneurisma gigante do ventrículo esquerdo: contributo diagnóstico de diferentes modalidades de imagem não invasivas. Rev Port Cardiol 2012; 31:439-44. [DOI: 10.1016/j.repc.2012.04.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2011] [Accepted: 11/04/2011] [Indexed: 11/25/2022] Open
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Oliveira SM, Dias P, Pinho T, Gavina C, Almeida PB, Madureira AJ, Pinho P, Ramos I, Maciel MJ. Giant left ventricular pseudoaneurysm: The diagnostic contribution of different non-invasive imaging modalities. REVISTA PORTUGUESA DE CARDIOLOGIA (ENGLISH EDITION) 2012. [DOI: 10.1016/j.repce.2011.11.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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9
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Singh S, Puri A, Narain V, Sahni J. Post-traumatic left ventricular pseudoaneurysm. Interact Cardiovasc Thorac Surg 2011; 14:359-61. [PMID: 22186128 DOI: 10.1093/icvts/ivr105] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
Left ventricular pseudoaneurysms (LVPs) occur as a complication of myocardial infarction, cardiac surgery and, rarely, due to thoracic trauma, infective pericarditis or iatrogenisis due to accidental perforation of the myocardium. Ventricular pseudoaneurysms are acquired by blood-filled spaces outside the cardiac chambers communicating with the ventricle. We present a case of LVP presented after a blunt non-penetrating chest injury. The patient underwent successful aneurysmorrhaphy.
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Affiliation(s)
- Sushil Singh
- Department of Cardiothoracic and Vascular Surgery, CSM Medical University, Lucknow, India.
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10
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Figtree GA, Lønborg J, Grieve SM, Ward MR, Bhindi R. Cardiac magnetic resonance imaging for the interventional cardiologist. JACC Cardiovasc Interv 2011; 4:137-48. [PMID: 21349451 DOI: 10.1016/j.jcin.2010.09.026] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2010] [Revised: 09/10/2010] [Accepted: 09/17/2010] [Indexed: 01/04/2023]
Abstract
Cardiac magnetic resonance imaging is a noninvasive technique for assessing heart structure and function without the need for ionizing radiation. Its ability to precisely outline regions of myocardial ischemia and infarction gives it an important role in guiding interventional cardiologists in revascularization. Its ability to characterize and precisely quantify abnormal regurgitant flow volumes or abnormal shunts also makes it a valuable tool for many noncoronary interventions. This review will discuss the evidence for cardiac magnetic resonance in guiding complex therapies in the catheter laboratory, as well as practical issues that need to be addressed to allow the application of this powerful tool to an increasing number of our patients.
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Affiliation(s)
- Gemma A Figtree
- North Shore Heart Research Group, Kolling Institute, University of Sydney, Sydney, Australia
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11
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Cardiovascular Magnetic Resonance Imaging. CARDIOVASCULAR MEDICINE 2007. [DOI: 10.1007/978-1-84628-715-2_7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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12
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Affiliation(s)
- Warren J Manning
- Beth Israel Deaconess Medical Center, Cardiovascular Division, Harvard Medical School, Boston, Massachusetts 02215, USA.
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13
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Yavuzgil O, Gürgün C, Apaydin A, Cinar CS, Yüksel A, Kültürsay H. A giant inferoposterior true aneurysm of the left ventricle mimicking a pseudoaneurysm. Int J Cardiovasc Imaging 2005; 22:205-12. [PMID: 16231081 DOI: 10.1007/s10554-005-9013-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2005] [Accepted: 06/25/2005] [Indexed: 11/29/2022]
Abstract
A left ventricular aneurysm (LVA) is most commonly the result of myocardial infarction, usually involving the anterior wall. A left ventricular pseudoaneurysm (LVPSA) or false aneurysm forms when cardiac rupture is contained by adherent pericardium or scar tissue. The accurate diagnosis, although difficult to establish, is an important one to make because these aneurysms are prone to rupture. In this article, we report a challenging case of a cardiac aneurysm a year after a coronary bypass operation which could not be definitively diagnosed despite of imaging with different techniques including echocardiography, coronary angiography, left ventriculography and magnetic resonance imaging (MRI). The patient underwent a second cardiac surgery, the aneurysm was resected, the mitral valve was replaced and the defect in the ventricular wall was repaired. Because of the combined diagnostic capabilities like detailed and functional pathoanatomy and aneurysmal wall characterization, MRI seems to have multiple advantages in differential diagnosis.
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Affiliation(s)
- Oguz Yavuzgil
- Department of Cardiology, Ege University Medical Faculty, Bornova, and Kent Hospital, Department of Radiology, Cigli, Izmir, Turkey.
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14
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Lakkireddy DR, Khan IA, Nair CK, Korlakunta HL, Sugimoto JT. Pseudo-pseudoaneurysm of the left ventricle: a rare complication of acute myocardial infarction--a case report and literature review. Angiology 2005; 56:97-101. [PMID: 15678263 DOI: 10.1177/000331970505600114] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Rupture of the cardiac wall is usually a fatal complication of acute myocardial infarction within the first 2 weeks. However, in certain cases a ruptured ventricular wall is contained by overlying adherent pericardium called pseudoaneurysm, whereas a true aneurysm is one that is caused by scar formation resulting in thinning of the myocardium. The patients with pseudoaneurysm may survive until the aneurysm ruptures. In exceedingly rare instance, the rupture of the myocardium is not transmural but remains circumscribed within the ventricular wall itself, but in communication with the ventricular cavity. This finding is defined as pseudo-pseudoaneurysm. The authors report a case of postinfarction posterobasal pseudo-pseudoaneurysm along with review of the literature on the subject.
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Abstract
The use of magnetic resonance (MR) imaging for cardiac diagnosis is expanding, aided by the administration of paramagnetic contrast agents for a growing number of clinical applications. This overview of the literature considers the principles and applications of cardiac MR imaging with an emphasis on the use of contrast media. Clinical applications of contrast material-enhanced MR imaging include the detection and characterization of intracardiac masses, thrombi, myocarditis, and sarcoidosis. Suspected myocardial ischemia and infarction, respectively, are diagnosed by using dynamic first-pass and delayed contrast enhancement. Promising new developments include blood pool contrast media, labeling of myocardial precursor cells, and contrast-enhanced imaging at very high fields.
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Affiliation(s)
- Robert R Edelman
- Department of Radiology, Evanston Northwestern Healthcare, 2650 Ridge Ave, Evanston, IL 60201, USA.
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16
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Bohdiewicz PJ. Single photon emission computed tomography radionuclide ventriculography in the noninvasive diagnosis and evaluation of a false left ventricular aneurysm (pseudoaneurysm). Clin Nucl Med 2003; 28:821-6. [PMID: 14508273 DOI: 10.1097/01.rlu.0000089524.97725.69] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
An inferior wall false aneurysm (pseudoaneurysm) was diagnosed in a 77-year-old male by single photon emission computed tomography (SPECT) radionuclide ventriculography (RNV). This immediately followed routine planar RNV because the latter did not lead to definitive characterization of the type of aneurysm and did not ideally characterize the location and size of the aneurysm. RNV was followed by false-negative first-pass radionuclide ventriculography, routine echocardiography, and gated magnetic resonance imaging of the heart (cardiac MRI). A definitive diagnosis of a false aneurysm is found at surgery and pathology; however, the patient declined surgery and has done well for 1.5 years after these imaging studies. The first-pass study is limited with relatively small pseudoaneurysms, like in this case. Echocardiography is noninvasive and can show wall motion and aneurysm size. Cardiac MRI is the most expensive noninvasive study but, in addition to revealing the diameters of the neck and body of the aneurysm, MRI is able to characterize the surrounding myocardium. This case report suggests the critical information needed for a confident, noninvasive diagnosis of false aneurysm can be obtained with SPECT RNV. The location of the aneurysm is easily determined, and the relative diameters of the neck to the body of the aneurysm can be easily seen. SPECT RNV is superior to planar RNV and first-pass radionuclide ventriculography in making a diagnosis of false aneurysm. Although RNV might be unable to directly demonstrate the perfusion and thickness of the myocardium, it has an advantage over MRI in terms of ejection fraction (EF) and cost.
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Affiliation(s)
- Paul J Bohdiewicz
- Department of Nuclear Medicine, William Beumont Hospital, Royal Oak, MI 48073, USA.
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Birnbaum Y, Chamoun AJ, Anzuini A, Lick SD, Ahmad M, Uretsky BF. Ventricular free wall rupture following acute myocardial infarction. Coron Artery Dis 2003; 14:463-70. [PMID: 12966268 DOI: 10.1097/00019501-200309000-00008] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
SUMMARY Ventricular free wall rupture remains a dreaded complication of acute myocardial infarction. A dramatic fatal presentation is not universal and if recognized early, especially in its sub-acute form, a therapeutic intervention may be lifesaving. Changing trends in its natural history and the previously described pathological subtypes have emerged since the advent of thrombolysis. Although frequently unpredictable, certain clinical, echocardiographic and electrocardiographic signs should suggest the diagnosis. Moreover, knowledge of predisposing risk factors and a high index of suspicion are helpful in early recognition of this complication. In recent years, several different therapeutic approaches have been described including percutaneous seals and surgical mechanical closure of ventricular free wall rupture. In this review, we sought to highlight established and debatable aspects of this pathology to hopefully enhance prompt diagnosis and treatment by all clinicians caring for patients suffering acute myocardial infarction.
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Affiliation(s)
- Yochai Birnbaum
- Division of Cardiology, Department of Internal Medicine, University of Texas Medical Branch, 5106 John Sealy Annex, 301 University Boulevard, Galveston, TX 77555-0553, USA.
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Kumbasar B, Wu KC, Kamel IR, Lima JAC, Bluemke DA. Left ventricular true aneurysm: diagnosis of myocardial viability shown on MR imaging. AJR Am J Roentgenol 2002; 179:472-4. [PMID: 12130455 DOI: 10.2214/ajr.179.2.1790472] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Basak Kumbasar
- Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins Hospital, Rm. 143, 600 N. Wolfe St., Baltimore, MD 21287, USA
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Lladó (coordinador) GP, Costa FC, Beiras AC, Domínguez JF, Romo AI, Jiménez Borreguero LJ, Gálvez y Rafaela Soler Fernández CP. Guías de práctica clínica de la Sociedad Española de Cardiología en resonancia magnética. Rev Esp Cardiol 2000. [DOI: 10.1016/s0300-8932(00)75125-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Abstract
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.
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Affiliation(s)
- C Frances
- Department of Medicine, University of California, San Francisco, USA.
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21
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Csapo K, Voith L, Szuk T, Edes I, Kereiakes DJ. Postinfarction left ventricular pseudoaneurysm. Clin Cardiol 1997; 20:898-903. [PMID: 9377830 PMCID: PMC6655895 DOI: 10.1002/clc.4960201021] [Citation(s) in RCA: 48] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/1997] [Accepted: 06/18/1997] [Indexed: 02/05/2023] Open
Abstract
Left ventricular wall rupture after myocardial infarction is a mechanical complication that may result in a pseudoaneurysm. Between January 1994 and October 1996, false or pseudoaneurysms were detected in 6 (0.0026%) of 2,600 consecutive patients (4 women, 2 men; mean age 59.4 years) undergoing cardiac catheterization at University Medical School, Debrecen, Hungary. All patients had a history of cardiovascular disease, with diagnosis of pseudoaneurysm confirmed by echocardiography. The average time from the occurrence of acute infarction to diagnosis was 37.0 days (range 3-80 days). All patients were in New York Heart Association functional class IV congestive heart failure; in four patients cardiogenic shock was present. Five patients underwent coronary angiography, which demonstrated multivessel disease and occlusion of the infarct-related artery (TIMIO) without adequate collateral circulation (grade 0-1). Five patients had surgical repair of the false aneurysm, and, in three patients, concomitant coronary bypass grafting was performed. The 2-year mortality rate for all patients was 50%. Early diagnosis of false aneurysm is facilitated by echocardiography, and coronary angiography is required before surgery. Early surgical correction with coronary revascularization is advised.
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Affiliation(s)
- K Csapo
- Department of Heart and Lung Diseases, University Medical School, Debrecen, Hungary
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22
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Brown SL, Gropler RJ, Harris KM. Distinguishing left ventricular aneurysm from pseudoaneurysm. A review of the literature. Chest 1997; 111:1403-9. [PMID: 9149600 DOI: 10.1378/chest.111.5.1403] [Citation(s) in RCA: 119] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
A postmyocardial infarction left ventricular pseudoaneurysm occurs when a rupture of the ventricular free wall is contained by overlying, adherent pericardium. A postinfarction aneurysm, in contrast, is caused by scar formation resulting in thinning of the myocardium. Although the usual treatment for patients with pseudoaneurysm is urgent surgical repair, the imaging characteristics of pseudoaneurysm and aneurysm, for which treatment is more conservative, are quite similar. The literature on the natural history and imaging characteristics of the two entities is reviewed, and an approach to distinguishing between the two entities is proposed.
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Affiliation(s)
- S L Brown
- Cardiovascular Division, Washington University School of Medicine, St. Louis, MO 63110, USA
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23
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Martin R, Tegtmeier T, Smith AS, Ognibene A. Left ventricular pseudoaneurysm presenting twenty-eight months after myocardial infarction. A case report. Angiology 1997; 48:177-81. [PMID: 9040274 DOI: 10.1177/000331979704800212] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
The authors report an unusually late presentation of a ventricular pseudoaneurysm more than two years after an inferior lateral myocardial infarction and the first case evaluated by Cine loop magnetic resonance imaging.
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Affiliation(s)
- R Martin
- Department of Internal Medicine, Northeastern Ohio Universities College of Medicine, Affiliated Hospitals at Canton, USA
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Nathaniel C, Lane S, Palma R, Scheinerman SJ, Missri JC, Schinnerman SJ. Pseudoaneurysm causing partial obliteration of the left atrium: case report and review. CATHETERIZATION AND CARDIOVASCULAR DIAGNOSIS 1996; 38:83-6. [PMID: 8722866 DOI: 10.1002/(sici)1097-0304(199605)38:1<83::aid-ccd19>3.0.co;2-t] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
We describe a case of left ventricular pseudoaneurysm with subepicardial dissection onto the left atrial wall, mimicking a smooth left atrial mass, causing partial obliteration of the left atrial cavity. This patient presented with a transient ischemic attack, most likely resulting from a thromboembolic episode to the brain. Emergent surgery was successfully performed and the patient is doing well at 1-year follow-up, with no signs of left atrial compression by transthoracic echocardiography.
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Affiliation(s)
- C Nathaniel
- St. Francis Hospital and Medical Center, Hoffman Heart Institute of Connecticut, Hartford 06105, USA
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