Echocardiographic demonstration of pseudoaneurysm after mitral valve replacement

A case of left ventricular pseudoaneurysm in the left atrioventricular groove after mitral valve replacement

Left ventricle-coronary sinus fistula and left ventricular pseudoaneurysm are unusual and frightening complications after mitral valve replacement. A 27-year-old female patient underwent mitral valve replacement 5 years previously and trans-thoracic echocardiography showed an outpouching lesion at the atrioventricular groove. It was difficult to differentiate whether the lesion was a left ventricle-coronary sinus fistula or a left ventricular pseudoaneurysm by two-dimensional echocardiography. Cardiac computed tomography confirmed a left ventricular pseudoaneurysm compressing the coronary sinus.

Echocardiographic findings and clinical features of left ventricular pseudoaneurysm after mitral valve replacement

We studied the echocardiographic findings and clinical features of left ventricular pseudoaneurysm after mitral valve replacement. From December 1979 to March 1991, 1050 patients underwent mitral valve replacement at our institute, and eight patients (0.8%) had left ventricular pseudoaneurysm. In all eight patients, left ventricular pseudoaneurysm developed after the second mitral valve replacement. The incidence of left ventricular pseudoaneurysm among 253 patients who had had previous mitral valve surgery was 3.1%. Seven of the eight patients were still alive and were followed up from 5 to 136 months (mean, 57 months) after the development of left ventricular pseudoaneurysm; these patients had no complications. One patient died as a result of low cardiac output after mitral valve replacement in spite of repair of the left ventricular pseudoaneurysm. This patient had a long and wide myocardial laceration near the left ventricular pseudoaneurysm. In the other seven patients, transthoracic echocardiography demonstrated a large extraventricular cavity along the posterobasal left ventricle. In five of these patients, a turbulent flow in the neck of the left ventricular pseudoaneurysm was recorded both in systole and diastole by pulsed and color Doppler echocardiography. Transesophageal echocardiography clearly showed the narrow neck of the left ventricular pseudoaneurysm and an abnormal flow between the left ventricle and the left ventricular pseudoaneurysm. Generally, when left ventricular pseudoaneurysm develops after mitral valve replacement, surgical repair is the first choice of therapy. Our study demonstrated, however, that the development of left ventricular pseudoaneurysm was not always associated with a poor prognosis without surgical intervention.(ABSTRACT TRUNCATED AT 250 WORDS)

Fistulous pseudoaneurysm complicating surgical accessory pathway interruption for Wolff-Parkinson-White syndrome

Pseudoaneurysms of the left ventricle are unusual operative complications that have commonly been associated with replacement of the mitral valve. In this report, we describe a 31-year-old man who was referred to our institution because of atypical chest pain. He had previously undergone three operations for ablation of an accessory pathway because of Wolff-Parkinson-White syndrome. A pseudoaneurysm of the left ventricle was noted on transesophageal echocardiography, biplanar left ventriculography, and ultrafast cine computed tomography of the heart. Elective surgical repair was successful. Although rare, this case demonstrates an unusual but potentially serious complication of surgical treatment of Wolff-Parkinson-White syndrome.

Successful repair of a submitral left ventricular infected pseudoaneurysm

Aneurysms of the left ventricle may be congenital or may occur after a myocardial infarction, trauma, or endocarditis. Infective endocarditis can cause destructive injury to the heart in various ways. This report describes the formation of an aneurysm of the left ventricle from trauma of a bacterial vegetation of the mitral valve. Early recognition by echocardiography and magnetic resonance imaging led to successful repair and prevented a catastrophic result.

Systolic compression of the right coronary artery by a pseudoaneurysm following mitral valve replacement

A patient who developed a pseudo-, or false, aneurysm following mitral valve replacement is presented here with the unique angiographic finding of systolic compression of the right coronary artery by the pseudoaneurysm. Clinical and angiographic features of this case along with a discussion of pseudoaneurysms and the significance and causes of systolic compression of coronary arteries are presented.

False inferior pseudoaneurysm: two-dimensional and Doppler echocardiographic findings

The noninvasive differentiation of true aneurysm from pseudoaneurysm is sensitively and specifically accomplished with two-dimensional echocardiography. Recent reports suggest that Doppler flow patterns may further enhance the specificity of the diagnosis of pseudoaneurysm. We present a patient with ventriculographic and two-dimensional echocardiographic features of an inferior pseudoaneurysm. Doppler examination, however, failed to show phasic flow characteristic of a small communicating orifice between two larger chambers. At surgery, a large posterolateral true aneurysm was found. Thus the addition of Doppler flow patterns to imaging information may help to distinguish pseudoaneurysms from true aneurysms.