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Mohamed AR, Alharbi A, Sajdeya O, Moustafa A, Younes S, Grande R. Left ventricular narrow-neck pseudoaneurysm following a redo mitral valve replacement. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2024; 59:17-20. [PMID: 37391324 DOI: 10.1016/j.carrev.2023.06.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 05/31/2023] [Accepted: 06/23/2023] [Indexed: 07/02/2023]
Affiliation(s)
| | | | - Omar Sajdeya
- Department of Internal Medicine, The University of Toledo, Toledo, OH, USA
| | | | - Stephanie Younes
- Division of Cardiovascular Medicine, Promedica-Toledo Hospital, Toledo, OH, USA
| | - Robert Grande
- Division of Cardiovascular Medicine, Promedica-Toledo Hospital, Toledo, OH, USA
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2
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Percutaneous closure of left ventricular pseudoaneurysm. Adv Cardiol 2022; 18:101-110. [PMID: 36051826 PMCID: PMC9421521 DOI: 10.5114/aic.2022.118525] [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: 02/22/2022] [Accepted: 06/02/2022] [Indexed: 11/19/2022]
Abstract
The aim of the present study is to describe the indications, treatment effects, and patient outcomes of percutaneous management of left ventricular pseudoaneurysm (LVPA). The study materials were based on comprehensive literature retrieval since 2004. The mechanisms of LVPA formation can be divided into surgical, percutaneous, and medial disease related. Of the surgical mechanisms, coronary artery bypass grafting prevailed. The formation time was the longest in medical disease-related LVPAs up to 44.4 months. The percutaneous procedures succeeded on the first try in 79 (84.9%) patients, whereas failures were encountered during the percutaneous manoeuvres in 14 (15.1%) patients. Percutaneous closure of LVPA was especially indicated for patients carrying a high surgical risk. The iatrogenic traumas, such as left ventricular venting, should be avoided to prevent this complication. The preliminary cut-off valves of oversize 3.3 mm and oversize ratio 1.6 should be followed for reference for device choice.
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3
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Czopak A, Chaykovska L. Minimally invasive bail-out transthoracic coiling of giant cardiac pseudoaneurysm with good long-term result. J Card Surg 2022; 37:1783-1786. [PMID: 35289967 DOI: 10.1111/jocs.16420] [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: 02/16/2022] [Accepted: 02/27/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND We report a case of successful minimally invasive transthoracic coiling of a left ventricle pseudoaneurysm after iatrogenic cardiac perforation with a good long-term result. The pseudoaneurysm could be repaired neither by an open surgery because of poor general state of the patient nor interventionally because of a partial sealing with an Amplatzer Septal Occluder blocking the tight neck of the aneurysm. METHODS AND RESULTS We performed a transthoracic coiling of the left ventricle pseudoaneurysm using a direct ultrasound-guided puncture via intercostal access below the lingula. The access puncture was performed during a single lung apnea at the end of an expiration phase with a contralateral single lung ventilation. The patient successfully recovered and has been followed-up during the 5 years. CONCLUSIONS Transthoracic coil embolization is a minimally invasive treatment option for otherwise inoperable patients with cardiac pseudoaneurysms with good long-term results.
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4
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Ishida S, Mutsuga M, Fujita T, Yagami K. Late-phase left ventricular pseudoaneurysm after three-time mitral valve surgery. J Surg Case Rep 2022; 2022:rjab602. [PMID: 35070262 PMCID: PMC8776402 DOI: 10.1093/jscr/rjab602] [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: 12/03/2021] [Accepted: 12/12/2021] [Indexed: 12/02/2022] Open
Abstract
Rupture of the left ventricular posterior wall is a fatal complication during mitral valve replacement (MVR), and rupture mainly occurs intraoperatively and up to several days after MVR, but it rarely occurs in the late phase, such as several years postoperatively. Late rupture occasionally presents as left ventricular pseudoaneurysms (LVPAs). A 40-year-old man who had a three-time history of mitral valve surgery for infectious endocarditis was incidentally found to have a left ventricular aneurysm with no symptoms. He underwent closure of a LVPA with MVR. Although there are various surgical techniques to close LVPAs after mitral valve repair, it is still a challenging problem. Here, we report the case of a patient who successfully underwent LVPA repair with MVR and describe the technique.
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Affiliation(s)
- Shinichi Ishida
- Correspondence address. Department of Cardiac Surgery, Gifu Prefectural Tajimi Hospital, 5-161 Maehata-cho, Tajimi-city, Gifu 507-8522, Japan. Tel: +81-572-22-5311; Fax: + 81-572-25-1246; E-mail:
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5
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Duan QJ, Duan CT, Yang WJ, Dong AQ. Conservative treatment of left ventricular pseudoaneurysm after mitral valve replacement due to early left ventricular rupture: a case report. J Cardiothorac Surg 2021; 16:69. [PMID: 33823893 PMCID: PMC8025552 DOI: 10.1186/s13019-021-01436-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Accepted: 03/16/2021] [Indexed: 11/16/2022] Open
Abstract
Background Left ventricular pseudoaneurysm due to early left ventricle rupture is a serious complication after cardiac surgery. Urgent surgery is recommended in most cases with a high mortality rate. Conservative treatment of a left ventricular pseudoaneurysm due to early left ventricle rupture is very rare. Case presentation We present a 61-year-old woman with left ventricular pseudoaneurysm after mitral valve replacement due to early left ventricle rupture. This patient was treated in a conservative approach. This patient had an uneventful recovery. She was in good condition and remained asymptomatic 3.5 years after mitral valve surgery. Conclusion This case suggests that medical treatment left ventricular pseudoaneurysm patients has a limited but acceptable role in selected and unusual circumstances. Supplementary Information The online version contains supplementary material available at 10.1186/s13019-021-01436-8.
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Affiliation(s)
- Qun-Jun Duan
- Department of Cardiovascular Surgery, School of Medicine, Second Affiliated Hospital of Zhejiang University, #88 Jiefang Road, Hangzhou, 310009, China
| | - Cui-Ting Duan
- Department of Nursing, Hangzhou Medical College, Hangzhou, China
| | - Wei-Jun Yang
- Department of Cardiovascular Surgery, School of Medicine, Second Affiliated Hospital of Zhejiang University, #88 Jiefang Road, Hangzhou, 310009, China
| | - Ai-Qiang Dong
- Department of Cardiovascular Surgery, School of Medicine, Second Affiliated Hospital of Zhejiang University, #88 Jiefang Road, Hangzhou, 310009, China.
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6
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Percutaneous closure of a left ventricular pseudoaneurysm after transcatheter ventricular septal defect closure. Cardiol Young 2020; 30:743-745. [PMID: 32308169 DOI: 10.1017/s1047951120000815] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Left ventricular pseudoaneurysm is very rare in children. Although surgery is conventional treatment, recently, percutaneous closure of pseudoaneurysms has been described. Here, we present the first case where a patient developed left ventricular pseudoaneurysm after percutaneous ventricular septal defect device closure and was treated by a second percutaneous method.
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7
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Arnaz A, Akansel S, Yalcinbas Y, Saygili A, Sarioglu T. Transcatheter Closure of Left Ventricular Pseudoaneurysm After Mitral Valve Replacement. Ann Thorac Surg 2020; 110:e123-e125. [PMID: 31982444 DOI: 10.1016/j.athoracsur.2019.12.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2019] [Revised: 11/27/2019] [Accepted: 12/06/2019] [Indexed: 10/25/2022]
Abstract
Left ventricular pseudoaneurysm (LVPA) is a rare but lethal complication of mitral valve replacement (MVR) or myocardial infarction. Early correction is necessary for patients with extensive and expanding LVPA. We report a transcatheter closure of LVPA after MVR. A 63-year-old woman presented with an LVPA 2 months after MVR. The repeated computed tomographic scan and transthoracic echocardiography showed enhancement of pseudoaneurysm. The LVPA was closed successfully with Amplatzer Vascular Plug using a transcatheter approach.
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Affiliation(s)
- Ahmet Arnaz
- Department of Cardiovascular Surgery, School of Medicine, Acibadem Mehmet Ali Aydinlar University, Istanbul, Turkey.
| | - Serdar Akansel
- Department of Cardiovascular Surgery, Istanbul Taksim Training and Research Hospital, Istanbul, Turkey
| | - Yusuf Yalcinbas
- Department of Cardiovascular Surgery, Acibadem Bakirkoy Hospital, Istanbul, Turkey
| | - Arda Saygili
- Department of Pediatric Cardiology, School of Medicine, Acibadem Mehmet Ali Aydinlar University, Istanbul, Turkey
| | - Tayyar Sarioglu
- Department of Cardiovascular Surgery, School of Medicine, Acibadem Mehmet Ali Aydinlar University, Istanbul, Turkey
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8
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Antonic M, Djordjevic A, Mohorko T, Petrovic R, Lipovec R, Juric P. Left ventricular pseudoaneurysm following atrioventricular groove rupture after mitral valve replacement. SAGE Open Med Case Rep 2019; 7:2050313X18823456. [PMID: 30719310 PMCID: PMC6349977 DOI: 10.1177/2050313x18823456] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2018] [Accepted: 12/14/2018] [Indexed: 11/17/2022] Open
Abstract
Left ventricular pseudoaneurysm is a partial cardiac rupture, contained by the surrounding pericardium that maintains communication with the left ventricular lumen. Whereas most cases of left ventricular pseudoaneurysms are related to myocardial infarction (loss of myocardial integrity), only a handful are associated with valve surgery. We present a female patient, who was admitted for elective mitral valve replacement. After the implantation of the mechanical valve, we encountered a rupture of the atrioventricular groove. After 3 months, a left ventricular pseudoaneurysm was found and the patient was reoperated. The valve was explanted and the inspection of the annulus and previously implanted pericardial patch revealed a loosened stitch on the inferior (ventricular) side. The defect was reinforced with additional stitches and the valve was reimplanted. In conclusion, we report an unusual case with two serious complications after mitral valve replacement - atrioventricular groove rupture and left ventricular pseudoaneurysm.
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Affiliation(s)
- Miha Antonic
- Department of Cardiac Surgery, University Medical Centre Maribor, Maribor, Slovenia
| | - Anze Djordjevic
- Department of Cardiac Surgery, University Medical Centre Maribor, Maribor, Slovenia
| | - Tamara Mohorko
- Department of Cardiac Surgery, University Medical Centre Maribor, Maribor, Slovenia
| | - Rene Petrovic
- Department of Cardiac Surgery, University Medical Centre Maribor, Maribor, Slovenia
| | - Robert Lipovec
- Department of Cardiac Surgery, University Medical Centre Maribor, Maribor, Slovenia
| | - Peter Juric
- Department of Cardiac Surgery, University Medical Centre Maribor, Maribor, Slovenia
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9
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Nagamine H, Date Y, Takagi T, Kawase Y. To repair or not to repair: a case report of atrioventricular groove hematoma during mitral valve surgery. J Cardiothorac Surg 2019; 14:8. [PMID: 30626444 PMCID: PMC6327444 DOI: 10.1186/s13019-018-0828-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2018] [Accepted: 12/27/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Atrioventricular groove hematomas during mitral valve surgery range from simple hematomas to complex atrioventricular disruptions that cause frank rupture with massive bleeding and subsequent mortality. A small or moderate-sized hematoma is reported to be present in the left atrioventricular groove in 10 to 30% of all patients immediately after mitral valve replacement. Despite the fact that atrioventricular groove hematomas are inherently unstable and unpredictable, conservative strategies are recommended due to the high mortality associated with additional surgical repair. Such conservative strategies, however, would not resolve the potential risk of rupture, and there also appears to be a certain degree of uncertainty to be overcome using the current advances in cardiac surgery. CASE PRESENTATION We present a case of atrioventricular hematoma during double valve replacement which was treated with conservative management. A left ventricular pseudoaneurysm developed after surgery, but spontaneously resolved completely within six months. After reflecting on our case, we developed a check sheet, including the anesthesiologist's transesophageal echocardiography findings, for reasonable intraoperative decision-making regarding conservative management vs. additional surgical repair. Our check sheet helps organize the pathophysiological understanding of the injury and integrates partial findings from complementary viewpoints, and can be used to accurately assess intense situations and develop a common understanding among surgical team members. CONCLUSIONS Our case involved an atrioventricular groove hematoma that occurred during mitral valve surgery and caused a left ventricular pseudoaneurysm. Conservative strategies yielded positive results. We hope our experience and original check sheet will be of value to surgical teams facing similar situations.
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Affiliation(s)
- Hiroshi Nagamine
- Department of Thoracic and Cardiovascular Surgery, Yokohama Sakae Kyosai Hospital, 132 Katsura-cho, Sakae-ku, Yokohama, Kanagawa 247-8581 Japan
| | - Yusuke Date
- Department of Thoracic and Cardiovascular Surgery, Yokohama Sakae Kyosai Hospital, 132 Katsura-cho, Sakae-ku, Yokohama, Kanagawa 247-8581 Japan
| | - Takeshi Takagi
- Department of Thoracic and Cardiovascular Surgery, Yokohama Sakae Kyosai Hospital, 132 Katsura-cho, Sakae-ku, Yokohama, Kanagawa 247-8581 Japan
| | - Yushi Kawase
- Department of Thoracic and Cardiovascular Surgery, Yokohama Sakae Kyosai Hospital, 132 Katsura-cho, Sakae-ku, Yokohama, Kanagawa 247-8581 Japan
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10
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Mathur M, Gupta S. Cardiac Pseudoaneurysm- A Death Defying Entity. J Clin Diagn Res 2016; 10:TD06-7. [PMID: 27504379 DOI: 10.7860/jcdr/2016/19956.7936] [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: 03/06/2016] [Accepted: 04/25/2016] [Indexed: 11/24/2022]
Abstract
A pseudoaneurysm refers to a contained rupture of the myocardium with a tenuous pericardium walling off the leak. It needs to be differentiated from a true aneurysm by the fact that there is lack of myocardial tissue in the wall of a pseudoaneurysm. The differentiation between the two is pertinent as true aneurysms can be treated medically while pseudoaneurysms require urgent surgical treatment. Untreated pseudoaneurysms carry a high risk of rupture and mortality. We report a case of cardiac pseudoaneurysm developing in a 46-year-old male who had suffered myocardial infarction four months back. The patient now presented with chest pain and dyspnoea. CECT chest revealed a partially thrombosed large pseudoaneurysm arising from the posterior wall of left ventricle. While the clinical diagnosis of this entity is difficult, CECT plays a pivotal role in the non-invasive detection of pseudoaneurysms.
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Affiliation(s)
- Manoj Mathur
- Associate Professor, Department of Radiodiagnosis, Government Medical College , Patiala, Punjab, India
| | - Saryu Gupta
- Assistant Professor, Department of Radiodiagnosis, Government Medical College , Patiala, Punjab, India
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11
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Neupane S, Kommuri NV, Kazanji N, Chowdhury P. Left ventricular pseudoaneurysm after mitral valve replacement. Echocardiography 2016; 33:1788-1789. [PMID: 27400412 DOI: 10.1111/echo.13294] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Development of left ventricular pseudoaneurysm is a rare complication of mitral valve surgery and requires urgent surgical intervention. We describe a case of pseudoaneurysm of membranous septum following repeat mitral valve replacement with the use of multimodality imaging.
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Affiliation(s)
- Saroj Neupane
- Department of Cardiology, St John Hospital and Medical Center, Detroit, Michigan
| | - Naga Va Kommuri
- Department of Cardiology, William Beaumont Hospital, Royal Oak, Michigan
| | - Noora Kazanji
- Department of Internal Medicine, William Beaumont Hospital, Royal Oak, Michigan
| | - Pertha Chowdhury
- Department of Cardiology, William Beaumont Hospital, Royal Oak, Michigan
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12
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Madan T, Juneja M, Raval A, Thakkar B. Transcatheter device closure of pseudoaneurysms of the left ventricular wall: An emerging therapeutic option. Rev Port Cardiol 2016; 35:115.e1-5. [PMID: 26852302 DOI: 10.1016/j.repc.2015.06.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2015] [Revised: 06/15/2015] [Accepted: 07/10/2015] [Indexed: 11/19/2022] Open
Abstract
Left ventricular pseudoaneurysm is a rare but serious complication of acute myocardial infarction and cardiac surgery. While surgical intervention is the conventional therapeutic option, transcatheter closure can be considered in selected patients with suitable morphology of the pseudoaneurysm. We report a case of successful transcatheter closure of a left ventricular pseudoaneurysm orifice and isolation of the sac using an Amplatzer septal occluder.
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Affiliation(s)
- Tarun Madan
- Cardiology Department, U. N. Mehta Institute of Cardiology and Research Centre, Ahmedabad, India
| | - Manish Juneja
- Cardiology Department, U. N. Mehta Institute of Cardiology and Research Centre, Ahmedabad, India.
| | - Abhishek Raval
- Cardiology Department, U. N. Mehta Institute of Cardiology and Research Centre, Ahmedabad, India
| | - Bhavesh Thakkar
- Cardiology Department, U. N. Mehta Institute of Cardiology and Research Centre, Ahmedabad, India
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13
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Transcatheter device closure of pseudoaneurysms of the left ventricular wall: An emerging therapeutic option. REVISTA PORTUGUESA DE CARDIOLOGIA (ENGLISH EDITION) 2016. [DOI: 10.1016/j.repce.2015.07.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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14
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Moriarty J, Harris TJ, Vorobiof G, Kwon M, Aboulhosn J. Direct Percutaneous Repair of Left Ventricular Pseudoaneurysm via Transthoracic Deployment of a Ventricular Septal Defect Closure Device. Tex Heart Inst J 2015; 42:362-6. [PMID: 26413020 DOI: 10.14503/thij-14-4243] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
In this case report, we describe direct percutaneous delivery of a muscular-ventricular-septal-defect occluder device to close a left ventricular pseudoaneurysm. The occluder was positioned and deployed with the aid of concurrent transthoracic ultrasonography, transesophageal echocardiography, and fluoroscopy. In contrast with previously published reports, we describe and illustrate a direct transthoracic route across the pseudoaneurysmal sac, which obviated the need for indirect transfemoral or transapical approaches.
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15
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Şahan E. Left ventricular pseudoaneurysm after mitral valve replacement. Herz 2015; 40:778-82. [DOI: 10.1007/s00059-015-4302-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2015] [Accepted: 03/01/2015] [Indexed: 11/28/2022]
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16
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Inoue T, Hashimoto K, Sakamoto Y, Nagahori R, Yoshitake M, Matsumura Y, Takagi T, Kinami H. Spontaneous closure of a large left ventricular pseudoaneurysm after mitral valve replacement. Gen Thorac Cardiovasc Surg 2014; 64:337-9. [PMID: 25224154 DOI: 10.1007/s11748-014-0474-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2014] [Accepted: 09/05/2014] [Indexed: 11/27/2022]
Abstract
Left ventricular pseudoaneurysm is a rare, but potentially fatal, condition that generally occurs as a complication of myocardial infarction, infective endocarditis, or cardiac surgery. Surgical repair is the treatment of first choice because of the marked risk of rupture, but deteriorated hemodynamics and complicated procedures to treat the pseudoaneurysm may lead to a high mortality rate. We report a 62-year-old woman with a large left ventricular pseudoaneurysm after mitral valve replacement for rheumatic mitral valve stenosis. Surgical repair was not performed due to the patient's refusal, but her pseudoaneurysm resolved spontaneously by 2 years after mitral valve replacement. Spontaneous obliteration of a large left ventricular pseudoaneurysm is very rare in a patient on warfarin therapy. This case suggests that a left ventricular pseudoaneurysm with a narrow neck may resolve spontaneously in rare settings.
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Affiliation(s)
- Takahiro Inoue
- Department of Cardiac Surgery, The Jikei University, 3-25-8 Nishishinbashi, Minato-ku, Tokyo, 105-8461, Japan.
| | - Kazuhiro Hashimoto
- Department of Cardiac Surgery, The Jikei University, 3-25-8 Nishishinbashi, Minato-ku, Tokyo, 105-8461, Japan
| | - Yoshimasa Sakamoto
- Department of Cardiac Surgery, The Jikei University, 3-25-8 Nishishinbashi, Minato-ku, Tokyo, 105-8461, Japan
| | - Ryuichi Nagahori
- Department of Cardiac Surgery, The Jikei University, 3-25-8 Nishishinbashi, Minato-ku, Tokyo, 105-8461, Japan
| | - Michio Yoshitake
- Department of Cardiac Surgery, The Jikei University, 3-25-8 Nishishinbashi, Minato-ku, Tokyo, 105-8461, Japan
| | - Yoko Matsumura
- Department of Cardiac Surgery, The Jikei University, 3-25-8 Nishishinbashi, Minato-ku, Tokyo, 105-8461, Japan
| | - Tomomitsu Takagi
- Department of Cardiac Surgery, The Jikei University, 3-25-8 Nishishinbashi, Minato-ku, Tokyo, 105-8461, Japan
| | - Hiroo Kinami
- Department of Cardiac Surgery, The Jikei University, 3-25-8 Nishishinbashi, Minato-ku, Tokyo, 105-8461, Japan
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Abhaichand RK, Sambasivam KA, Wilson B. Left ventricular pseudoaneurysm following balloon mitral valvuloplasty. Asian Cardiovasc Thorac Ann 2014; 23:970-2. [PMID: 24637027 DOI: 10.1177/0218492314529135] [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: 11/15/2022]
Abstract
Balloon mitral valvotomy is a commonly performed procedure for mitral stenosis. This procedure can lead to complications such as left ventricular perforation with tamponade, mitral regurgitation and stroke. Here we report a case of left ventricular pseudoaneurysm following balloon mitral valvotomy. It was a consequence of adherent pericardium secondary to open mitral valvotomy performed earlier. It was surgically corrected by pseudoaneurysm repair and mitral valve replacement. We believe that this is the first such reported case.
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Affiliation(s)
| | | | - Bivin Wilson
- Department of Cardiology, GKNM Hospital, Coimbatore, India
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Dudiy Y, Jelnin V, Einhorn BN, Kronzon I, Cohen HA, Ruiz CE. Percutaneous Closure of Left Ventricular Pseudoaneurysm. Circ Cardiovasc Interv 2011; 4:322-6. [DOI: 10.1161/circinterventions.111.962464] [Citation(s) in RCA: 74] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background—
Left ventricular pseudoaneurysm is a rare but serious complication from myocardial infarction and cardiac surgery. Although standard treatment is surgical intervention, percutaneous closure of left ventricular pseudoaneurysm has become an option for high-risk surgical candidates. Experience with percutaneous treatment is limited to a few single case reports. This is the first series of percutaneous treatment of the left ventricular pseudoaneurysms.
Methods and Results—
This is a retrospective analysis of 9 procedures of percutaneous repair of left ventricular pseudoaneurysm in 7 consecutive patients (ages 51 to 83 years, 6 men) completed in our Structural Heart Disease center from June 2008 to December 2010. All patients were considered as a high risk for surgery because of multiple comorbidities. Multiple imaging modalities were used before, during, and after the procedures to improve success and efficacy. The left ventricular pseudoaneurysms of all 7 patients were successfully repaired. Fluoroscopy time on average was 36.5±24.0 minutes (range, 12.4 to 75.7 minutes). All patients were followed up for a period ranging from 3 to 32 months after the procedure. Each patient improved by at least 1 New York Heart Association functional class, and 4 patients improved by 2 classes.
Conclusions—
Transcatheter closure of the left ventricular pseudoaneurysm is a feasible alternative for high-risk surgical candidates. The use of multiple imaging modalities is required for a detail planning and execution of the procedure.
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Affiliation(s)
- Yuriy Dudiy
- From the Lenox Hill Heart and Vascular Institute of New York, NY
| | - Vladimir Jelnin
- From the Lenox Hill Heart and Vascular Institute of New York, NY
| | - Bryce N. Einhorn
- From the Lenox Hill Heart and Vascular Institute of New York, NY
| | - Itzhak Kronzon
- From the Lenox Hill Heart and Vascular Institute of New York, NY
| | - Howard A. Cohen
- From the Lenox Hill Heart and Vascular Institute of New York, NY
| | - Carlos E. Ruiz
- From the Lenox Hill Heart and Vascular Institute of New York, NY
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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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20
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Rekik S, Trabelsi I, Charfeddine H, Krichene S, Hentati M, Kammoun S. Rapid Occurrence of Giant Left Ventricular Pseudoaneurysm after Mitral Valve Replacement. Echocardiography 2008. [DOI: 10.1111/j.1540-8175.2008.00754.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Subannular left ventricular pseudoaneurysm following mitral valve replacement. J Cardiothorac Surg 2008; 3:28. [PMID: 18489767 PMCID: PMC2424049 DOI: 10.1186/1749-8090-3-28] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2007] [Accepted: 05/19/2008] [Indexed: 11/23/2022] Open
Abstract
Delayed development of left ventricular pseudoaneurysm is a rare late complication of mitral valve prosthesis and requires early surgical intervention. Here we describe the occurrence of such a complication diagnosed 6-months after the valve surgery in a 60-year-old lady. The anatomic delineation of subannular left ventricular pseudoaneurysm using multiple imaging modalities including CT angiography is also being discussed.
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22
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Makaryus AN, Manetta F, Goldner B, Stephen B, Rosen SE, Park CH. Large Left Ventricular Pseudoaneurysm Presenting 25 Years After Penetrating Chest Trauma. J Interv Cardiol 2005; 18:193-200. [PMID: 15966925 DOI: 10.1111/j.1540-8183.2005.04057.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Penetrating chest wounds leading to damage of thoracic structures are common. A rare sequelae of chest trauma is a contained rupture of the left ventricle of the heart leading to the development of a pseudoaneurysm. This complication needs prompt recognition and repair because of the high likelihood of rupture and death. We report the case of a 47-year-old man who underwent repair of a stab wound to the heart 25 years ago and subsequently developed a large left ventricular pseudoaneurysm and presented with angina.
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Affiliation(s)
- Amgad N Makaryus
- Division of Cardiology, North Shore-Long Island Jewish Health System, Long Island Jewish Medical Center, New Hyde Park, New York 11040, USA
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23
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Hirasawa Y, Miyauchi T, Sawamura T, Takiya H. Giant Left Ventricular Pseudoaneurysm After Mitral Valve Replacement and Myocardial Infarction. Ann Thorac Surg 2004; 78:1823-5. [PMID: 15511485 DOI: 10.1016/j.athoracsur.2003.07.018] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/17/2003] [Indexed: 11/26/2022]
Abstract
Left ventricular pseudoaneurysm is a rare but serious complication of mitral valve replacement or myocardial infarction. Prompt surgical correction is mandatory in cases of a large left ventricular pseudoaneurysm. A 70-year-old man had a giant left ventricular pseudoaneurysm after myocardial infarction and mitral valve replacement. The orifice of the pseudoaneurysm was closed with an e-polytetrafluoroethylene patch and the pseudoaneurysmal wall was almost resected.
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Affiliation(s)
- Yujiro Hirasawa
- Division of Cardiovascular Surgery, Gifu Prefectural Gifu Hospital, Gifu City, Japan.
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24
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Hung MJ, Cherng WJ, Kuo LT, Wang CH. Echocardiographic characteristics of patients surviving nonsurgically treated left ventricular pseudoaneurysm after acute myocardial infarction. Am J Cardiol 2003; 91:328-31. [PMID: 12565090 DOI: 10.1016/s0002-9149(02)03161-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Affiliation(s)
- Ming-Jui Hung
- Cardiology Section, Department of Medicine, Chang Gung Memorial Hospital, Keelung, Taiwan
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25
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Sepic J, Aranki SF, Cohn LH. Minimally invasive Port-Access repair of a left ventricular pseudoaneurysm. J Thorac Cardiovasc Surg 2002; 124:1242-3. [PMID: 12447197 DOI: 10.1067/mtc.2002.125264] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
- Jerome Sepic
- Division of Cardiac Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass. 02115, USA.
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26
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Abstract
We report an unusual case of left ventricular pseudoaneurysm late after mitral valve replacement. A 60-year-old woman, who had undergone aortic and mitral valve replacement using mechanical prostheses 4 months previously, presented with severe congestive heart failure. The computed tomographic scan of the chest demonstrated a large mass displacing the heart anteriorly. The orifice of the pseudoaneurysm was successfully closed on the beating heart using partial femorofemoral bypass through a left thoracotomy.
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Affiliation(s)
- Minoru Ono
- Division of Cardiothoracic Surgery, The Ohio State University, Columbus, USA.
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27
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Guzmán G, Moya JL, Catalán P, Ortega J, de Pablo C, Asín E. [Left ventricular pseudoaneurysm with a fistula to right ventricle following previous repair of septal defect after acute myocardial infarction]. Rev Esp Cardiol 2000; 53:1287-91. [PMID: 10978241 DOI: 10.1016/s0300-8932(00)75231-6] [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: 11/19/2022]
Abstract
A case of left ventricular pseudoaneurysm with a fistula to right ventricle is presented. It appeared following the repair of a ventricular septal defect after acute myocardial infarction. The left ventricular pseudoaneurysm is associated, in most cases, with acute myocardial infarction. However, we should not forget surgery as aetiology of this pathology. The most frequent post-surgery pseudoaneurysms appear after aneurysmectomy and after mitral valve replacement. They tend to develop fistulas which differ from post acute myocardial infarction pseudoaneurysms. Few cases have been described following the repair of septal defect and none of them complicated with a fistula to right ventricle, as in our case.
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Affiliation(s)
- G Guzmán
- Instituto de Cardiología. Hospital Ramón y Cajal. Madrid
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28
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Abstract
BACKGROUND We present a review of our experience with acquired pseudoaneurysms of the left ventricle in order to establish the risk of surgical repair. METHODS Ten patients operated upon for a left ventricular pseudoaneurysm in our clinic between 1984 and 1999 were reviewed. The pseudoaneurysm, a complication of myocardial infarction (four acute and three chronic) or previous cardiac surgery (three chronic), was resected in all patients and the ventricular wall defect closed with direct sutures (five cases) or a patch (five cases). Coronary artery bypass graft was performed in 6 patients. RESULTS Three patients died (postoperative mortality 30%) after repair of an acute postinfarction (2 patients) or a chronic postsurgical (1 patient) pseudoaneurysm. Three patients died during follow-up (median 4 years) of a carcinological (2 patients) or cardiac (1 patient) cause. Two years after repair, 5 patients were in New York Heart Association class I or II, and 1 patient was in class III. CONCLUSIONS Repair of left ventricular pseudoaneurysms can be performed with acceptable results, although mortality is significant in acute myocardial infarction and redo operations. Propensity for fatal rupture, however, is higher than the surgical risk in acute pseudoaneurysms or in large or expanding chronic ones and warrants surgical repair. The best approach to small asymptomatic chronic pseudoaneurysm is unsettled.
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Affiliation(s)
- R Prêtre
- Department of Cardiovascular Surgery, University Hospital Zürich, Switzerland.
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29
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Abstract
We report two unusual cases of left atrial wall dissection creating a left atrial pseudoaneurysm associated with regurgitation a few months after mitral valve replacement. We emphasize the important role of transesophageal echocardiography in the diagnosis. The two patients successfully underwent surgery.
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Affiliation(s)
- M Idir
- Hôpital Cardiologique du Haut-Lévêque, Avenue de Magellan, 33 604 Pessac, France
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30
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Abstract
Significant advances in imaging modalities have occurred to evaluate prosthetic valve function and associated complications. These developments involve predominantly the introduction of Doppler technology for the non-invasive determination of gradients and valve areas and TEE for an improved assessment of valve structure, function, and associated complications. The current role of cinefluoroscopy is mostly to complement TEE in the evaluation of motion of mechanical prosthetic valves in the aortic position. Cardiac catheterization is now rarely needed to assess valve function. Diagnosis of prosthetic valve obstruction can be performed in the majority of cases with transthoracic Doppler echocardiography. Differentiation of valve obstruction from normal valve function in small valves with high flow conditions, however, may be difficult. Because of this and the variability in normal valves among different prostheses, knowledge of the type and size of the implanted valve is essential. Patients and ultrasound laboratories are encouraged to seek and provide this information on a routine basis. Although transthoracic echocardiography is the main diagnostic modality for the serial evaluation of prosthetic valve function, it is important to recognize its limitations in assessing prosthetic mitral regurgitation and evaluating structural abnormalities of prosthetic valves. These are the situations in which TEE has the most impact. A summary of general indications of TEE in prosthetic valves is provided in Table 6. Finally, a baseline transthoracic Doppler study is essential in the overall follow-up and serial evaluation of valve function. For future comparisons, the best indices of valve functions are those obtained for patients as their own control, from a baseline Doppler echocardiographic study performed early after the operation.
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Affiliation(s)
- J Barbetseas
- Department of Medicine, Baylor College of Medicine, Houston, Texas, USA
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31
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Takeuchi M, Kuroiwa A. Echocardiographic Detection of Two Distinct Left Ventricular Pseudoaneurysms After Mitral Valve Replacement. Echocardiography 1997; 14:267-270. [PMID: 11174953 DOI: 10.1111/j.1540-8175.1997.tb00720.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Left ventricular pseudoaneurysm after mitral valve replacement (MVR) is a rare but clinically significant complication. We report a case of two distinct left ventricular pseudoaneurysms after re-MVR, which was correctly diagnosed by two-dimensional echocardiography, and subsequently confirmed by surgery.
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Affiliation(s)
- Masaaki Takeuchi
- Second Department of Internal Medicine, University of Occupational and Environmental Health, 1-1 Iseigaoka Yahatanishi-ku, Kitakyushu, Fukuoka, 807, Japan
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32
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Fazia RB, Lewis JF, Mills RM, Normann S, Conti CR. Prolonged survival of a patient with left ventricular pseudoaneurysm following myocardial infarction and mitral valve replacement. Chest 1996; 109:577-9. [PMID: 8620745 DOI: 10.1378/chest.109.2.577] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
We present the case of a patient with left ventricular pseudoaneurysm following acute myocardial infarction. Survival for 2 years following diagnosis, despite the large size of the aneurysm, and subsequent management with cardiac transplantation represent unusual and interesting aspects of this complication of myocardial infarction.
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Affiliation(s)
- R B Fazia
- Department of Medicine, University of Florida, Gainesville, USA
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33
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Bolognesi R, Cucchini F, Lettieri C, Manca C, Visioli O. Left ventricular false aneurysm: an unusually prolonged natural history. CATHETERIZATION AND CARDIOVASCULAR DIAGNOSIS 1995; 36:46-50; discussion 51-2. [PMID: 7489592 DOI: 10.1002/ccd.1810360111] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
A case of left ventricular false aneurysm of postinfarctual etiology with an unusually prolonged natural history (12 years survival) is reported. A first diagnosis of this rare cardiac complication was made in 1982 on the basis of hemodynamic and echocardiographic results. At that time the patient rejected surgical therapy. Eleven years later the patient came back to our attention after resuscitation from a sudden cardiac death. Hemodynamic and echocardiographic (transesophageal) tests showed a remarkable impairment of left ventricular function and an abnormal enlargement (10 x 8 cm) of a pseudoaneurysmatic cavity full of thrombi. The patient died suddenly in April 1994. We emphasize the unusual, prolonged survival of our patient suffering from an unresected left ventricular false aneurysm of postinfarctual etiology.
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Affiliation(s)
- R Bolognesi
- Cattedra di Cardiologia, Università degli Studi di Parma, Italy
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34
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Tokunaga S, Yoshitoshi M, Mayumi H, Nakano E, Toshima Y, Kawachi Y, Yasui H. Left ventricular-coronary sinus shunt through a septal aneurysm after mitral valve re-replacement. Ann Thorac Surg 1995; 59:224-7. [PMID: 7818333 DOI: 10.1016/0003-4975(94)00347-a] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
We describe a case in which a left ventricular-coronary sinus communication through a dissecting ventricular septal aneurysm developed after a redo mitral valve replacement. The outlet orifice of the communication was located in the side wall of the ostium of the coronary sinus. Both the communication and the aneurysm were successfully dealt with by performing a right atriotomy and by opening the aneurysm from its outlet orifice.
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Affiliation(s)
- S Tokunaga
- Division of Cardiovascular Surgery, Shimonoseki Municipal Hospital, Yamaguchi, Japan
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35
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Fehske W, Kranidis A, Kirchhoff PG, Omran H, Lauck G, Lüderitz B. Diagnosis of a posterior left ventricular pseudoaneurysm by multiplane transesophageal echocardiography. JOURNAL OF CLINICAL ULTRASOUND : JCU 1995; 23:59-62. [PMID: 7699097 DOI: 10.1002/jcu.1870230113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
Affiliation(s)
- W Fehske
- University of Bonn, Department of Cardiology, Germany
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36
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Rittoo D, Sutherland GR. Posterior left ventricular pseudoaneurysm after aortic valve replacement in a patient with rheumatoid arthritis: diagnosis by transesophageal echocardiography. J Am Soc Echocardiogr 1994; 7:429-33. [PMID: 7917356 DOI: 10.1016/s0894-7317(14)80206-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
A 58-year-old man with seropositive rheumatoid arthritis underwent successful aortic valve replacement because of severe aortic regurgitation. One year later, prosthetic valve endocarditis was suspected clinically and he was referred for echocardiography. On transthoracic echocardiography an unusual echo-free space adjacent to the inferobasal segments of the left ventricle and extending behind the left atrium was visible. No further diagnostic information could be obtained from precordial examinations. Biplane transesophageal echocardiography demonstrated the presence of a pulsatile pseudoaneurysm of the left ventricle arising posteriorly, close to the anulus of the mitral valve. There was no evidence of endocarditis.
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Affiliation(s)
- D Rittoo
- Department of Cardiology, Western General Hospital, Edinburgh, Scotland
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37
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Esakof DD, Vannan MA, Pandian NG, Cao QL, Schwartz SL, Bojar RM. Visualization of left ventricular pseudoaneurysm with panoramic transesophageal echocardiography. J Am Soc Echocardiogr 1994; 7:174-8. [PMID: 8185963 DOI: 10.1016/s0894-7317(14)80124-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
The diagnosis and precise delineation of a pseudoaneurysm of the left ventricle have important implications regarding surgical planning and operative repair. A 68-year-old man was admitted to the hospital with the incidental finding of a large pseudoaneurysm of the left ventricle 6 months after a St. Jude mitral valve replacement performed for partial papillary muscle rupture after an acute myocardial infarction. Panoramic transesophageal echocardiography provided a full depiction of the left ventricle and the adjoining pseudoaneurysm, enhancing the preoperative evaluation of the extent of the defect. A successful repair was undertaken with a pericardial patch.
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Affiliation(s)
- D D Esakof
- Cardiovascular Imaging and Hemodynamic Laboratory, Tufts-New England Medical Center, Boston, MA 02111
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