Post myocardial infarction left ventricular pseudoaneurysm

Diagnosis of Postinfarction Pseudoaneurysm of the Left Ventricular Free Wall after Coronary Stenting: Case Report

The article is dedicated to topical issues of diagnosis and surgical treatment of postinfarction left ventricular (LV) myocardial rupture. Postinfarction LV rupture is one of the most life-threatening complications of acute myocardial infarction (AMI). Given the low prevalence, this complication almost always leads to a fatal outcome. At the same time, a large proportion of patients (over 60%) die before the diagnosis is verified, suddenly, without specific clinical precursors. The aim. To draw the attention of doctors to the problem of diagnosis and surgical treatment of LV myocardial rupture as a complication of AMI. The article describes a clinical case of diagnosis of pseudoaneurysm of the LV free wall after coronary stenting. The peculiarity of this case was absence of a typical pain syndrome, electrocardiographic and echocardiographic signs, suggesting the presenceof such a mechanical complication of AMI. Special attention is paid to the analysis of factors enabling to assess the risk of developing this complication in patients with AMI. The given clinical case demonstrates the importance of early hospitalization and myocardial revascularization by stenting in order to prevent mechanical complications of AMI. Timely diagnosis and urgent surgical treatment of LV myocardial ruptures can reduce mortality due to mechanical complications of AMI. Conclusions. Timely hospitalization and revascularization of the myocardium in AMI patients reduce the risk of LV rupture in the affected area. The use of echocardiography makesit possible to detect severe complications of AMI with sufficient sensitivity. The only effective treatment method forLV rupture is urgent surgical intervention. Postinfarction myocardial rupture repair is a difficult task considering the initial severity of the patient’s clinical condition, the significant volume and technical complexity of the surgical intervention.

Pseudoaneurysm Development after Free Wall Rupture Post Myocardial Infarction

Background: According to the World Health Organization, cardiovascular disease is the number one cause of death globally, claiming millions of lives each year with an increasing prevalence. Myocardial infarction (MI) makes up a large sum of these deaths each year. While MI in itself is lethal, there are several complications that can increase the morbidity and mortality of an MI, such as left ventricular wall rupture and aneurysms. Case Presentation: We present a case of an elderly male with an extensive cardiac history who presented with a non-ST segment myocardial infarction (NSTEMI) managed with percutaneous coronary intervention. Hours after, he became hemodynamically unable and was found to have a pseudoaneurysm of the left ventricle. Despite aggressive efforts, his pseudoaneurysm ruptured and he ultimately succumbed to his condition. Conclusions: Left ventricular pseudoaneurysm is usually seen after myocardial infarctions with a rupture rate of up to 45% leading to a mortality rate of about 50%. While cardiac catheterization with left ventriculography is the gold standard for diagnosis, echocardiography can also be used as an alternative. Treatment is emergent cardiac surgery but still holds a high operative risk. Therefore, patients may be medically stabilized and managed prior to ultimate surgical intervention.

Left ventricular free-wall rupture, a potentially lethal mechanical complication of acute myocardial infarction: an unusual and illustrative case report

BACKGROUND

There are three major mechanical complications after acute myocardial infarction: left ventricular free-wall rupture, ventricular septum rupture and acute mitral valve regurgitation. The left ventricular free-wall rupture is a serious and often lethal complication following an ST elevation myocardial infarction. However, very rarely this rupture can be contained by the pericardium, forming a pseudoaneurysm.

CASE PRESENTATION

We report a case of a 66-year-old man with multiple cardiovascular risk factors and previous ST elevation myocardial infarction, complaining of atypical chest pain. His electrocardiogram was in normal sinus rhythm, with the presence of Q wave in inferior leads and T-wave inversion in lateral leads. A transthoracic echocardiogram showed a left ventricular pseudoaneurysm. In the coronary angiography, multi-vessel disease was found. On-pump CABG was performed and a posterolateral left ventricular giant pseudoaneurysm were observed. Due its "petrous" consistency it was impossible to perform an aneurysmectomy.

CONCLUSIONS

The diagnosis of left ventricular pseudoaneurysm can be difficult, as patients often present either asymptomatic or with non-specific symptoms attributed to other causes. A multimodality imaging diagnostic approach can be necessary. Immediate surgery is considered the treatment of choice because untreated pseudoaneurysms have a high risk of rupture leading to cardiac tamponade, shock and death.