Surgical treatment of acquired left ventricular pseudoaneurysms

A Case of Left Ventricular Pseudoaneurysm as a Complication of Late-Presenting ST-Segment Elevation Myocardial Infarction

This case report delineates the clinical trajectory and management strategies of a 59-year-old Hispanic male diagnosed with a left ventricular pseudoaneurysm (LVPA) following a delayed presentation of ST-segment elevation myocardial infarction (STEMI), for which reperfusion treatment was not administered. Initially, an echocardiogram demonstrated an extensive anterolateral myocardial infarction, severe left ventricular systolic dysfunction, and an early-stage left ventricular apical aneurysm with thrombus, leading to the initiation of warfarin. Metabolic myocardial perfusion imaging via positron emission tomography indicated a substantial myocardial scar without viability, guiding the decision against revascularization. Post discharge, the patient, equipped with a wearable cardioverter defibrillator for sudden cardiac death prevention, experienced symptomatic ventricular tachycardia, which was resolved with defibrillator shocks. Subsequent imaging revealed an acute LVPA adjacent to the existing left ventricular aneurysm. Given the high surgical risk, conservative management was elected, resulting in thrombosis and closure of the pseudoaneurysm after two weeks. The patient eventually transitioned to home hospice, surviving an additional five months. This report underscores the complexities and therapeutic dilemmas in managing post-MI LVPA patients who are ineligible for surgical intervention.

Surgical treatment of a left ventricular pseudoaneurysm with an extracellular matrix patch

Left ventricle pseudoaneurysm is a rare and life-threatening complication of myocardial infarction that is formed as a result of left ventricle free wall rupture contained by the overlying pericardium. Urgent surgical repair is crucial, and in most reports, left ventricle was reconstructed with a Dacron or bovine pericardial patch. We present a case of a 66-year-old female with left ventricle pseudoaneurysm which was successfully repaired with an extracellular matrix patch.

Supplementary Information

The online version contains supplementary material available at 10.1007/s12055-023-01669-3.

Anterior basal left ventricular pseudoaneurysm in a single vessel disease

INTRODUCTION

Left ventricular pseudoaneurysm is a rare but serious clinicopathologic entity.

MATERIALS AND RESULTS

This article describes a case report of 51-year-old man who experienced recurrence of chest pain and dyspnea 4 months later after anterior ST elevation myocardial infarction of first diagonal branch. Anterior basal left ventricular pseudoaneurysm was diagnosed and successful surgical treatment was performed. One year after operation, patient has no cardiovascular events and remains in NYHA class II.

CONCLUSION

Cardiac magnetic resonance should be performed, if there is a suspicion of left ventricular pseudoaneurysm from transthoracic echocardiography. Surgery is the treatment of choice in case of left ventricular pseudoaneuryms because untreated lesions carry a significantly high risk of rupture.

Left ventricular pseudoaneurysm as a complication of LVAD explant

Left ventricular (LV) pseudoaneurysms are a rare disease entity associated with a multitude of etiologies. We describe the radiographic findings of an LV pseudoaneurysm arising as a complication of a leaking left ventricular assist device (LVAD) closure device. Computed tomographic angiography (CTA) imaging demonstrated an apical LV wall defect with a preperitoneal collection of extravasated contrast. A review of the patient's surgical history revealed prior LVAD placement and explant with placement of an LV closure device. Familiarity with the radiologic manifestation of LV pseudoaneurysms is critical to establish a prompt diagnosis and facilitate timely therapeutic intervention.

Delayed Giant Pseudoaneurysm With Left-to-Right Shunt Following Postinfarct Ventricular Septal Perforation Repair

Left ventricular pseudoaneurysm with a left-to-right shunt is extremely rare, requiring surgery if symptomatic; however, surgery has a high risk. Here, the case of a 77-year-old man with heart failure symptoms is reported, in which he develops a giant left ventricular pseudoaneurysm 16 months after ventricular septal perforation repair as a result of acute myocardial infarction, with mild shunt blood flow from the pseudoaneurysm to the right ventricle. Intraoperative findings showed a free wall rupture along the area where the patch was secured during the initial surgery. The patient was discharged on postoperative day 13, and postoperative examination revealed no abnormalities.

Concomitant valve surgery is associated with worse outcomes in surgical treatments of post-infarction ventricular aneurysm

Objective

To evaluate the impact of concomitant valve surgery on the prognosis of patients who experienced coronary artery bypass graft (CABG) with/without ventricular reconstruction for the ventricular aneurysm.

Methods

In our department, 354 patients underwent CABG with/without ventricular reconstruction for a ventricular aneurysm from July 23rd, 2000 to December 23rd, 2022. A total of 77 patients received concomitant valve surgery, 37 of whom underwent replacement, and 40 of whom underwent repair. The baseline characteristics, prognostic, and follow-up information were statically analyzed. Univariate and multivariate Cox regression analyses were applied to identify the risk factors of long-term outcomes.

Results

Compared with patients who did not undergo valvular surgery, patients who experienced concomitant valve surgical treatments had a significantly lower survival rate (p = 0.00022) and a longer total mechanical ventilation time. Subgroup analysis indicated that the options of repair or replacement exhibited no statistically significant difference in postoperative mortality (p = 0.44) and prognosis. The multivariate Cox regression analysis suggested that the pre-operative cholesterol level (HR = 1.68), postoperative IABP (HR = 6.29), NYHA level (HR = 2.84), and pre-operative triglyceride level (HR = 1.09) were independent and significant predictors for overall all-cause mortality after surgery.

Conclusion

Concomitant valve surgery was considerably related to a higher risk of postoperative mortality in patients with post-infarction ventricle aneurysms who underwent surgical treatments. No significant difference in the prognosis outcomes was observed between the operating methods of repair or replacement valve surgery.

Left ventricular pseudoaneurysmectomy in patient without hemodynamic instability: A case report

We present a case of a 66-year-old male with a history of two previous diagnoses of myocardial infarction, followed by drug-eluting stent implantation. During the check-up, he complained of dyspnea, fatigue, and dizziness. Echocardiography revealed a massive left ventricular pseudoaneurysm (LVP). According to the patient's clinical manifestations and radiologic data, urgent surgical intervention was performed. Postoperatively, several complications appeared, which were managed successfully. The patient was discharged in stable condition. This is an interesting case of massive LVP without hemodynamic instability.

A Dual Atrioventricular Approach to Repair Pseudoaneurysm after Mitral Valve Surgery

Background  Left ventricular pseudoaneurysm (LVPA) is an uncommon but potentially fatal complication following atrioventricular groove rupture. Case Description  We present a patient with a massive LVPA involving the lateral commissure and under the mitral P3 segment following coronary artery bypass grafting and mitral valve (MV) repair. MV replacement and arteriovenous pseudoaneurysm were repaired by dual approach via the left atrium with excision of the previously dehisced mitral ring to expose the defect and patch repair the atrioventricular defect through the pseudoaneurysm free wall. Conclusion  This is a rare case of a large subacute postoperative LVPA repaired by dual atrial-ventricular approach to treat a contained atrioventricular groove rupture.

Left Ventricular Pseudoaneurysms Discovered Early After Acute Myocardial Infarction: The Surgical Timing Dilemma

Left ventricular pseudoaneurysm is a rare disease; it is defined as a ventricular rupture contained by epicardium, pericardial adhesions, or both. It most frequently occurs as a complication of acute myocardial infarction. Surgical treatment is recommended for pseudoaneurysms that are large or symptomatic and for those discovered less than 3 months after myocardial infarction. We report our experience with 2 patients who had left ventricular pseudoaneurysms discovered less than a week after inferior myocardial infarction. Both patients were middle-aged men with right coronary occlusion in whom the diagnoses were established by echocardiography during the first week after infarction. Because both patients were clinically stable, we opted to defer surgery until scarring could facilitate correction; this decision was based on a review of the literature showing that in-hospital mortality is higher with early surgery. The patients were monitored closely in the intensive care unit and were prescribed β-blockers and vasodilators. Both patients underwent left ventricular patch reconstruction with exclusion of the pseudoaneurysm and posterior septum; both received moderate inotropic support and prophylactic intra-aortic balloon pump assistance. Their postoperative courses were uneventful. In 5 prior reports describing 45 patients (13 with acute pseudoaneurysm [≤2 wk after infarction] and 32 with nonacute pseudoaneurysm), in-hospital mortality was 61.5% for patients in the acute group and 15.6% for the nonacute group (P = .0066). We recommend that clinicians consider deferring surgery for patients with stable acute left ventricular pseudoaneurysm to reduce the risks associated with early repair.

Case report: Spontaneous closure of ventricular pseudoaneurysm post-acute myocardial infarction with non-surgical therapy

Left ventricle (LV) pseudoaneurysm is a rare disorder post-acute myocardial infarction (AMI). Resection or closure of the pseudoaneurysm by surgery is recommended due to the high propensity of pseudoaneurysm rupture while surgery has also high risks. Conservative therapy could be acceptable in small pseudoaneurysms or patients with high surgical risks. Nevertheless, the risk evaluation and grasp of indication are not clear. This case reported an acute cyst-like LV pseudoaneurysm formation post-AMI-induced myocardial free wall rupture (MFWR), and the patient recovered with spontaneous closure of the fissure and shrinkage of the LV pseudoaneurysm through non-surgical therapy. Based on the observations in the echocardiogram, we proposed that intermittent closing of the fissure and interruption of the blood flow between the LV and the pseudoaneurysm due to LV contraction alleviated stress change on the pseudoaneurysm. The narrow fissure, small pseudoaneurysm, and intermittently interrupted blood flow that benefit fissure healing and pseudoaneurysm stabilization could indicate the prognosis of this patient. Drugs like β-blocker that decreased the stress on the pseudoaneurysm also led to the risk reduction of pseudoaneurysm rupture. To our knowledge, this is the first case that reports a spontaneous closure of LV pseudoaneurysm. The size of the fissure and the pseudoaneurysm, as well as the corresponding hemodynamic state, could be valuable to evaluate the risk and prognosis of the pseudoaneurysm. Optimized medical management was also helpful to pseudoaneurysm stabilization.

Communicating Coronary and Ventricular Pseudoaneurysms Complicating Coronary Artery Perforation

We present the case of a 75-year-old man who experienced rebleeding after surgical treatment of grade III coronary perforation, resulting in intertwined complications including communicating coronary and ventricular pseudoaneurysms. The percutaneous intervention of sealing the rebleeding site with a covered stent implantation managed this rare pseudoaneurysm successfully. (Level of Difficulty: Advanced.)

Percutaneous closure of left ventricular pseudoaneurysm

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.

Left ventricular pseudoaneurysm repair utilizing P2 segment of mitral valve: a case report

Background

Left ventricular (LV) pseudoaneurysms are a rare occurrence typically seen after myocardial infarction (MI) or in patients with prior cardiac surgery and are associated with a significant risk of rupture and mortality. Management includes primary repair, epicardial patching, or percutaneous repair with occlusive devices.

Case presentation

This case report describes a 46-year-old male with a large LV pseudoaneurysm that was surgically patched with a segment of his mitral valve. To our knowledge, there has not been a documented repair utilizing a segment of the mitral valve.

Conclusions

The applicability of this technique is limited to cases with posteriorly located pseudoaneurysms near the mitral valve, thus allowing the P2 segment to be used as a patch. This is a novel approach to LV pseudoaneurysm repair, though careful consideration towards patient selection is warranted, as comorbid conditions may contribute to morbidity and mortality.

Successful surgical treatment of delayed left ventricular pseudoaneurysm related to Candida albicans infection after repair of ventricular septal rupture complicating acute myocardial infarction

Left ventricular (LV) pseudoaneurysm is a rare complication after postinfarction repair of ventricular septal rupture (VSR), and surgical treatment of this condition due to mycosis has rarely been reported. We report a rare case of successful surgical treatment of delayed LV pseudoaneurysm related to Candida albicans infection after repair of VSR due to myocardial infarction. A 75-year-old woman was admitted for fever and severe inflammatory reaction. Two and a half years previously, she had undergone postinfarct VSR repair and was treated for mycotic infective endocarditis due to C. albicans. Transthoracic echocardiography and computed tomography revealed a LV pseudoaneurysm (maximum transverse diameter 6.2 cm). The cause of the LV pseudoaneurysm was suspected to be infectious, and broad-spectrum antibiotic treatment was started. Fourteen days after admission, she developed acute abdominal pain and an elevated β-D-glucan level because the LV pseudoaneurysm ruptured. Emergency surgical treatment was performed with antimycotic drug therapy. The LV wall defect was reconstructed using bovine pericardium under cardiopulmonary support. Her postoperative course was good, and she was discharged to home. Echocardiography revealed no recurrence of the LV pseudoaneurysm at 4 months postoperatively. During 1 year of follow-up, the patient had been doing well without any infection or adverse event.

<Learning objective: The development of a left ventricular (LV) pseudoaneurysm after repair of postinfarction ventricular septal rupture (VSR) is rare, and the cause of this condition is often unknown. Moreover, LV pseudoaneurysm due to mycosis has rarely been reported and is thought to have a poor prognosis. We report a rare case of successful surgical treatment of delayed LV pseudoaneurysm related to Candida albicans infection after repair of VSR complicating acute myocardial infarction.>

Surgical and Conservative Treatment of Post-infarction Left Ventricular Pseudoaneurysm

Background

Post-infarction left ventricular (LV) pseudoaneurysm is a rare mechanical complication of myocardial infarction that carries a substantial risk of sudden rupture. The purpose of this study was to compare the surgical results of post-infarction LV pseudoaneurysm with those of conservative treatment.

Methods

From 2016 to 2021, 22 patients were hospitalized for LV pseudoaneurysm, including 17 cases (77.3%) caused by myocardial infarction. Of the 17 patients, 10 (58.8%) underwent surgical repair, while seven (41.2%) were treated medically. The clinical course, echocardiograph data, and surgical outcomes were analyzed. Survival rates of the surgical and conservative groups were compared.

Results

There were no perioperative deaths. Intra-aortic balloon pumping support was required in two (20%) patients. No follow-up mortality was observed in the surgical group and at the last follow-up, all the patients were classified as New York Heart Association class I–II. In the conservative group, there was one (14.3%) hospital death and two (28.6%) additional deaths during follow-up. A significant difference was found in survival between the two groups (P = 0.024).

Conclusions

Surgical repair of post-infarction LV pseudoaneurysm can be performed with good results, while conservative treatment carries a significant risk of sudden death. Surgical repair is indicated for every patient diagnosed, even those with a small pseudoaneurysm without symptoms.

3D model-guided transcatheter closure of left ventricular pseudoaneurysm: a case series

Left ventricular pseudoaneurysm (LVPsA) is a rare complication of myocardial infarction, cardiac surgery, chest trauma, infection or transcatheter interventions. It may cause arrhythmias, mass effect, thromboembolism and life-threatening rupture. The transcatheter approach is nowadays considered a cost-effective alternative to surgery. In this setting, 3D printing could be an emerging, powerful tool to plan transcatheter closure and choose the best occluding device. This study reports on three cases of complex LVPsA successfully treated by transcatheter device implantation guided by printed 3D heart models.

Percutaneous closure of left ventricular pseudoaneurysm using simultaneous transseptal and transapical approach: a case report

Background 

Left ventricular (LV) pseudoaneurysm (PSA), also referred to as contained LV wall rupture, is a clinically uncommon but potentially life-threatening condition that can occur after myocardial infarction or cardiac surgery. If the anatomic characteristics of LV PSA are not eligible for the transfemoral approach, percutaneous closure of LV PSA can be technically difficult and appropriate approach selection may contribute to procedural success.

Case summary 

An enlarging LV PSA was discovered in a 65-year-old man with Marfan syndrome and three prior cardiothoracic surgeries. Arterial access was not possible due to invagination of the previously placed surgical graft in the descending thoracic aorta. This was managed with a novel approach of simultaneous transseptal LV access and direct puncture of PSA through the chest wall followed by a vascular plug placement.

Discussion 

This case demonstrates that percutaneous LV PSA closure using a hybrid approach of transseptal and direct apical puncture is a feasible and effective alternative for high-risk surgical candidates, although the anatomic characteristics are unsuitable for the transfemoral approach.

Giant pseudoaneurysm that developed seven years after surgical repair of a postinfarction ventricular septal defect

Left ventricular pseudoaneurysm is a rare complication after myocardial infarction or cardiac surgery. An 88-year-old woman who developed a left ventricular pseudoaneurysm 7 years after the repair of a postinfarction ventricular septal defect was admitted to our hospital with a complaint of a pulsatile epigastric mass, which had persisted for a month. Enhanced computed tomography revealed a large left ventricular pseudoaneurysm that extended to the subcutaneous epigastric tissue through the supra-diaphragmatic space. Dehiscence of the patch on the lateral side, which was used during previous surgery, provided the entry site. Surgical repair with aneurysm exclusion patch plasty was successful, and the patient was discharged without any complications.

Surgical Treatment of Chronic Giant Left Ventricular Pseudoaneurysm

Left ventricle pseudoaneurysm is usually a severe complication of acute myocardial infarction, caused by rupture of the myocardial wall with pericardium bleeding. Mortality can reach 50 to 80% within a week if not properly treated. Hemodynamic instability, cardiac tamponade, and cardiac arrest are life-threatening presentations that require surgical treatment. We report a case of a man with a left ventricle chronic giant pseudoaneurysm and unspecific symptoms. After critical judgement on a heart team basis, surgical treatment was successfully performed, with a good long-term clinical outcome.

A giant left ventricular pseudoaneurysm diagnosed after double-valve replacement

A diagnostic coronary catheter injury to the subaortic region in a 41-year-old woman with rheumatic heart disease led to a pseudoaneurysm that later caused extrinsic left coronary compression. She subsequently underwent double-valve replacement, overlooking the pseudoaneurysm that enlarged to a giant size three months later following thrombolysis for mitral prosthesis thrombosis. A thrombolysis-induced large intracerebral hemorrhage posed a significant risk for reoperation, and mechanical prosthetic valves in the aortic and mitral positions allowed a catheter option only, through percutaneous transapical access. Interventional closure of the pseudoaneurysm is discussed in this unique report.

Post-infarction left ventricular free wall rupture: 12-years experience from the Cardiac Centre of the Institute of Clinical and Experimental Medicine in Prague, Czech Republic

BACKGROUND

Post-infarction left ventricular free wall rupture (LVFWR) is a feared and catastrophic complication of myocardial infarction that carries a high surgical and hospital mortality. Due to the rarity of this complication, little information exists on surgical treatment and outcomes. Goal and Methods. The goal of this study was to present our experience with LVFWR. We present a retrospective cohort of 19 consecutive patients who were surgically treated in the Cardiac Centre of the Institute of Clinical and Experimental Medicine in Prague between January 2006 and December 2017.

RESULTS

Thirty-day mortality was 26%. Five patients died. Four patients died in the operating theatre and one patient on the ninth postoperative day following re-rupture. Seventy-four percent of the patient cohort survived and were discharged from hospital. The median length of follow-up was 45 months (range 0.75-150). No patient died during follow-up. Median postoperative ejection fraction was 45% (range 25-65%). Angina pectoris and dyspnea were investigated during follow-up and graded according to the Canadian cardiology society (CCS) and the New York Heart Association (NYHA) classifications. Fourteen patients had CCS class I, eight patients had NYHA class I dyspnea and six patients had NYHA class II. Re-rupture occurred after hospital discharge in one patient one month after the original surgery. The patient was treated successfully by urgent surgical intervention.

CONCLUSION

LVFWR is a catastrophic and challenging complication of myocardial infarction. Good outcomes can be achieved by rapid diagnosis and urgent surgical intervention as shown by our results.

[Giant left ventricular false aneurysme revealing a silent myocardial infarction]

Left ventricular false aneurysms are rare. They are secondary to a myocardial rupture which is contained by adherent pericardium and scar tissue. LV pseudoaneurysm contains no endocardium or myocardium unlike left ventricular true aneurysm. Most cases of LV pseudoaneurysm are related to acute myocardial infarction in inferior or posterior wall. We report a case of a 56-year-old man with a medical history of chronic cigarette smoking, dyslipidemia, and obesity. The patient had no myocardial infarction before. He was admitted for evaluation of important shortness of breath at effort without chest pain for 5 months. Physical exam find an enlarged left ventricular. The electrocardiogram revealed Q waves and ST segment elevation in leads V1 to V6. Transthoracic echocardiogram showed a large thrombosed apical left ventricular false aneurysm, severe left ventricular dysfunction, which were confirmed by cardiac magnetic resonance imaging, this exam also showed no viability in the mid left anterior descending coronary artery territory. The coronary angiography showed an occlusion of the mid left anterior descending coronary artery and a stenosis of the first diagonal artery. The patient was offered a surgical aneurysectomy with coronary artery bypass. The surgery was successful with amelioration of symptoms. We present a rare case of a giant false left ventricular aneurysm complicating a silent myocardial infarction in the anterior wall. The diagnosis is made by cardiac echocardiogram and cardiac magnetic resonance imaging. Because of the important risk of rupture, the surgical treatment is required.

Sudden death due to left ventricular thrombosis: A report of two autopsy cases

PURPOSE

In this paper, we report two rare cases of sudden death due to giant left ventricular thrombus revealed at autopsy and we discuss the manner and the cause of death.

RESULTS

Cases presentation: The two cases reported are about two men aged 55 and 53 years respectively. In the two cases, no past cardiac history was found. Prior to the onset of complications and subsequent death, both patients presented to the emergency department with progressing asthenia, faintness and shortness of breath, were treated symptomatically. At autopsy, atherosclerosis of coronary arteries was found. In the first case, death was attributed to thrombosis of the pseudoaneurysm. In the second case, it was due to thrombosis complicating a myocardial infarction. The mechanism of death in the first case was explained by the hemodynamic shock caused by a total left ventricular pseudoaneurysm thrombosis secondary to old myocardial infraction. In the second case, death was the consequence of a cardiogenic shock secondary to thrombosis of the cardiac pseudoaneurysm complicating a myocardial infraction.

CONCLUSION

Complications of myocardial infarction represent frequent causes of adult sudden death. Left ventricular thrombosis is a complication that is often fatal and its discovery during an autopsy remains rare. The first-line doctor must take these types of complications into consideration in order to detect them and thus ensure timely management.

Transcatheter Closure of Left Ventricular Pseudoaneurysm After Mitral Valve Replacement

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.

Late Post- Infarction Left Ventricular Pseudoaneurysm: A Case Report

We present a case of a 90 year-old-patient who presented with syncope. She had previous inferior acute myocardial infarction 10 years ago. Coronary angiography revealed left ventricular pseudoaneurysm, which was confirmed on cardiac computed tomography. The patient refused surgical repair and implantable cardioverter defibrillator insertion and was discharged from the hospital alive. This case demonstrates the possibility of long-term survival with left ventricular pseudoaneurysm and the increasing detection of 'incidental' left ventricular pseudoaneurysm with more frequent use of imaging.

One aneurysm and two pseudoaneurysms, same patient

Ventricular pseudoaneurysms are rare pathological entities that mainly arise in the context of myocardial infarction or post-cardiac surgery. The clinical presentation is usually non-specific, and at times patients are asymptomatic. Mortality is high even with timely surgical intervention.The authors present a case of postoperative recurrence of a left ventricular pseudoaneurysm superimposed on an ischaemic true aneurysm.

To repair or not to repair: a case report of atrioventricular groove hematoma during mitral valve surgery

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.

Case report: Unusual presentation of haemopericardium with haemodynamic instability secondary to a coronary graft pseudoaneurysm treated by an endovascular approach

Background

Case summary

Discussion

Incidental Finding of Left Ventricular False Chamber: Diagnostic and Therapeutic Implications

We present the case of a 75-year-old man with incidental finding of a left ventricular false chamber at echocardiography. A multimodality imaging approach including also transesophageal echocardiography and cardiac magnetic resonance imaging allowed to better characterize the lesion and identify it as a pseudoaneurysm. Surgery showed an infective aetiology, which is rare, due to the finding of a large abscess in the cavity.

Left Ventricular Pseudoaneurysm: An Overview of Diagnosis and Management

Left ventricular pseudoaneurysm is a rare but life-threatening disorder that is frequently reported secondary to myocardial infarction or cardiac surgery. In this article, we chronicle the case of a patient with no prior risk factors who presented with a 2-week history of nonexertional atypical left chest pain. Apical 2-chamber transthoracic echocardiography revealed an unexpected outpouching of basal inferoseptal wall of the left ventricle, which had a narrow neck and relatively wide apex. The patient was diagnosed with left ventricular pseudoaneurysm and medical therapy was initiated. He refused to undergo the surgical intervention and subsequently, he was discharged from the hospital in stable condition. This article illustrates that physicians should be vigilant for atypical presentations of left ventricular pseudoaneurysm, and a high index of suspicion should be maintained for this stealth killer while performing appropriate diagnostic imaging. Additionally, we review the currently available approaches to diagnosis and management in these patients.

Repair of Enlarging Left Ventricular Pseudoaneurysm Two Months After Coronary Artery Bypass Grafting

Enlarging left ventricular pseudoaneurysms are a rare complication (especially after surgical revascularization) and require tailored surgical decision making and techniques for repair. We present a challenging patient with a rapidly enlarging left ventricular pseudoaneurysm 4 weeks after coronary bypass. The repair was approached through a left thoracotomy using circulatory arrest with selective antegrade cerebral perfusion.

Left ventricular outflow tract pseudoaneurysm diagnosed with point-of-care ultrasound in the emergency department

Left ventricular outflow tract pseudoaneurysms are a rare but life-threatening disorder, often caused by complications of cardiac surgery or myocardial infarction. We present a case report of a patient with no prior risk factors who presented with a six-month history of progressive exertional dyspnea, bilateral leg swelling and cough. Point-of-care ultrasound revealed an unexpected outpouching of the left ventricle. He was diagnosed with a left ventricular outflow tract pseudoaneurysm and subsequently went into cardiogenic shock secondary to extension of pseudoaneurysm causing extrinsic compression of the coronary arteries. The patient underwent successful emergency surgical repair and made a full recovery.

Post myocardial infarction left ventricular pseudoaneurysm

Left ventricular pseudoaneurysm is a rare yet serious and challenging complication of myocardial infarction that requires a high index of suspicion as the clinical presentation is highly variable. We present a case of post infarction thrombosed left ventricular pseudoaneurysm in a patient who presented with non-specific complaints months after the initial cardiac injury. Multimodality imaging helped in characterizing the pseudoaneurysm and planning for definite therapy.

Left Ventricular Postinfarction Pseudoaneurysm: Diagnostic Advantages of Three-Dimensional Echocardiography

We present a case of posterior left ventricular pseudoaneurysm, a rare but potentially lethal complication of inferior acute myocardial infarction. The clinical findings and the customary, noninvasive diagnostic methods used are illustrated. Particularly, the most evident display obtained by the employment of three-dimensional echocardiography in comparison to those supplied by two-dimensional ultrasonic method was illustrated.

Clinical characteristics and outcomes of left ventricular pseudoaneurysm: A retrospective study in a single-center of China

Left ventricular (LV) pseudoaneurysm is a fatal and rare condition with a high risk of rupture. The symptoms are nonspecific and diagnosis is often delayed. The purpose of this study is to analysis a series of cases in our institution.Between March 2009 and April 2016, 10 patients (5 males and 5 females) with LV pseudoaneurysm were retrospectively enrolled. Clinical information, diagnostic imaging modalities, treatment, and outcomes were evaluated.The mean age was 58.2 ± 11.0 years (28-71 years). The common symptoms were chest pain (3 cases), dyspnea (3 cases), and syncope (2 cases). All patients had nonspecific abnormalities on the electrocardiogram, and 7 patients had chest X-ray abnormalities. Three etiologies including myocardial infarction (6 cases), mitral valve replacement (3 cases), and suspected endocarditis (1 case) were identified. LV pseudoanerysm was diagnosed in 8 patients by transthoracic echocardiography, and the other 2 patients were diagnosed by computed tomography angiogram. Posterior (4 cases) and lateral (4 cases) of the left ventricle were the most common positions of the rupture orifice. Eight patients accepted surgery repair and 2 patients were treated conservatively. In 2 patients, residual apical aneurysm was found, 1 patient was detected with a residual LV pseudoaneurysm, and 1 patient had myocardial infarction at 61 months' follow-up.Myocardial infarction was the most common etiology of patients with LV pseudoaneurysm. The most frequently ruptured orifices were lateral and posterior walls of the left ventricle. Surgery is recommended as the first option, and conservative therapy can be considered for appropriate patients.

Surgical treatment of post-infarction left ventricular pseudoaneurysm: Case series highlighting various surgical strategies

Introduction and objective

The left ventricular pseudoaneurysm (LVP) is rare, the surgical experience is limited and its surgical treatment remains still a challenge with an elevated mortality. Herein, it is presented a retrospective analysis of our experience with acquired post infarct LVP over a10-year period.

Materials and methods

Between January 2006 through August 2016, a total of 13 patients underwent operation for post infarct pseudoaneurysm of the left ventricle. There were 10 men and 3 women and the mean age was 61 ± 7.6 years. 4 patients presented acute LVP. Two patients had preoperative intraortic balloon pump implantation.

Results

Various surgical techniques were used to obliterate the pseudoaneurysm such as direct pledgeted sutures buttressed by polytetrafluoroethylene felt, a Gore-Tex or Dacron patch, transatrial closure of LVP neck in submitral pseudoaneurysm, or linear closure in cases presenting associated postinfarct ventricular septal defect. Concomitant coronary artery bypasses were performed for significant stenoses in 12 patients, ventricular septal defect closure in 4 patients, mitral valve replacement in 3 and aortic valve replacement in 1 patient. Operative mortality was 30.8% (4 patients). Three of them were acute LVP. Three patients required the continuous hemodyalisis and 8 patients required intra-aortic balloon pump. At follow-up two deaths occurred at 1 and 3 years after surgery.

Conclusion

In conclusion, this study revealed that surgical repair of post infarct left ventricular pseudoaneurysm was associated with an acceptable surgical mortality rate, that cardiac rupture did not occur in surgically treated patients.

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Objective: Our experience with post-infarction left ventricular pseudoaneurysms (LVP) and surgical techniques in 13 patients.

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Various techniques: 1) direct pledgeted sutures; 2) single patch; 3) double-patch; 4) pericardial patch through the left atrium.

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Hospital mortality 4 (30.7%). Literature review: 306 patients with LVP undergoing surgery with 21.2% (65 deaths) mortality.

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In conclusion, this study revealed that surgical repair of LVP was associated with an acceptable surgical mortality rate.

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Cardiac rupture did not occur. Various techniques are available and should be considered according to the case presentation.

Management of Left Ventricular Free Wall Rupture Associated with Acute Myocardial Infarction

Left ventricular free wall rupture is one of the mechanical complications of acute myocardial infarction and it may result in cardiac tamponade as well as limiting itself by forming a pseudoaneurysm. In this report, a case of left ventricular free wall rupture and pseudoaneurysm that developed during the course of posterior myocardial infarction has been presented. Left ventricular free wall rupture and pseudoaneurysm were identified by three-dimensional transthoracic echocardiography and surgically repaired at a late stage.

Left Ventricular Pseudoaneurysm Following Inferior Myocardial Infarction: A Case for Conservative Management

Left ventricular pseudoaneurysm is a rare complication of myocardial infarction that carries a high mortality rate. Although conventional wisdom suggests prompt surgical repair in order to mitigate risk of expansion and rupture, there are some data to support non-operative management in asymptomatic individuals with likely chronic pseudoaneurysms, particularly when surgical candidacy is poor. We present a case of a medically managed left ventricular pseudoaneurysm subsequent to inferior ST-segment elevation myocardial infarction with 6-month follow-up data.

Atrioventricular Septum Pseudoaneurysm As Late Complication After Repeated Mitral Valve Replacement

We report the case of a pulsatile mass found in a patient who presented for a routine echocardiogram. The mass turned out to be an exceedingly rare mitral-subannular pseudoaneurysm involving the membranous atrioventricular septum with systolic expansion protruding into right atrium, discovered late after repeated multiple valve replacement surgery. Although these pseudoaneurysms may present asymptomatically, surgical intervention might be indicated because of the risk of rupture. This report describes this rare finding, discusses possible pathophysiological mechanisms, and underscores the importance of multimodality imaging to achieve correct identification and delimitation to guide surgical intervention in such cases.

Left ventricular pseudoaneurysm perceived as a left lung mass

Left ventricular pseudoaneurysm is a rare complication of aneurysmectomy. We present a case of a surgically treated left ventricular pseudoaneurysm, which was diagnosed three years after coronary artery bypass grafting and left ventricular aneurysmectomy. The presenting symptoms, diagnostic evaluation, and surgical repair are described.

Large left ventricular pseudoaneurysm and spontaneous recanalized coronaries

35 year old with ruptured lateral wall of Left ventricle (LV) resulting in large pseudo aneurysm contained within the pericardium [Figure 1]. There was free flow of blood between the LV and pseudoaneurysm.He underwent endoventricular patch plasty of the defect after opening the wall of aneurysm [Figure 2].

Posttraumatic Left Ventricular Pseudoaneurysm in a Child

A 7-year-old boy developed a left ventricular pseudoaneurysm after being struck by a tractor. The pseudoaneurysm was diagnosed and successfully resected 5 years after the accident.