1
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Gupta S, Ankush A, Gandhi P, Gupta V. Cardiac MRI in the diagnosis and management of left ventricular pseudoaneurysms with previous myocardial infarction: A report of two cases. Radiol Case Rep 2024; 19:4242-4247. [PMID: 39135675 PMCID: PMC11318547 DOI: 10.1016/j.radcr.2024.07.007] [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: 06/19/2024] [Revised: 06/27/2024] [Accepted: 07/03/2024] [Indexed: 08/15/2024] Open
Abstract
A left ventricular pseudoaneurysm, an ominous consequence of acute myocardial infarction, poses a significant threat to patient well-being. Prompt and accurate diagnosis is crucial for improving patient outcomes. This report describes diagnostic imaging findings for identifying left ventricular pseudoaneurysms, emphasizing the critical role of cardiac magnetic resonance imaging alongside other modalities. We present two cases of patients with a history of myocardial infarction who presented with palpitations, chest pain, and shortness of breath. Initial 2D echocardiography in both patients revealed aneurysmal dilation of the left ventricle. Cardiac MRI was then performed, confirming the diagnosis in both cases.
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Affiliation(s)
- Shagun Gupta
- LN Medical College and JK Hospital, Kolar Road, Bhopal, Madhya Pradesh, India
| | - Ankush Ankush
- LN Medical College and JK Hospital, Kolar Road, Bhopal, Madhya Pradesh, India
| | - Prateek Gandhi
- Government Medical College, Near Hanuman Nagar, Nagpur, Maharashtra, India
| | - Vivek Gupta
- LN Medical College and JK Hospital, Kolar Road, Bhopal, Madhya Pradesh, India
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2
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Banerjee S, Singhal M, Pannu AK. Left Ventricular Pseudoaneurysm. J Emerg Med 2024; 67:e318-e320. [PMID: 39060120 DOI: 10.1016/j.jemermed.2024.04.011] [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: 02/19/2024] [Revised: 04/06/2024] [Accepted: 04/22/2024] [Indexed: 07/28/2024]
Affiliation(s)
- Sudipto Banerjee
- Department of Internal Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Manphool Singhal
- Department of Internal Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India; Department of Radiodiagnosis, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Ashok Kumar Pannu
- Department of Internal Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
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3
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Tribak M, Adanho CM, Elmourabit Y, Saadouni Y, Elkettani OEC, Leghlimi LH, Soufiani A, Bendagha N, Agoumy Z, Elmhadi S, Lachhab F, Marmade L, Moughil S. Incidental diagnosis of a large left ventricular pseudoaneurysm. Radiol Case Rep 2024; 19:4108-4112. [PMID: 39104447 PMCID: PMC11299581 DOI: 10.1016/j.radcr.2024.06.039] [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: 06/04/2024] [Revised: 06/08/2024] [Accepted: 06/12/2024] [Indexed: 08/07/2024] Open
Abstract
Left ventricular pseudoaneurysm is a rare complication of myocardial infarction and represent a myocardial rupture contained within a pericardial space limited by adhesions. Differentiating it from a left ventricular aneurysm can be a real diagnostic challenge. We report a case of a 50-year-old man admitted for symptoms of left heart failure. Transthoracic echocardiography and cardiac computed tomography scan incidentally showed a large lateral left ventricular pseudoaneurysm measuring 75/50 mm in diameter. Patch closure was carried out under cardiopulmonary bypass. Postoperative follow up was uneventful. This case demonstrates the increasing detection of «incidental» left ventricular pseudoaneurysm with more frequent use of multimodality imaging techniques including cardiac CT scan.
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Affiliation(s)
- Mohammed Tribak
- Department of Cardiovascular surgery “B”, Ibn Sina University Hospital, Mohamed V University, Rabat, Morocco
| | - Christ-Marion Adanho
- Department of Cardiovascular surgery “B”, Ibn Sina University Hospital, Mohamed V University, Rabat, Morocco
| | - Yassine Elmourabit
- Department of Cardiovascular surgery “B”, Ibn Sina University Hospital, Mohamed V University, Rabat, Morocco
| | - Youssef Saadouni
- Department of Cardiovascular surgery “B”, Ibn Sina University Hospital, Mohamed V University, Rabat, Morocco
| | - Omar Ech-cherif Elkettani
- Department of Cardiovascular surgery “B”, Ibn Sina University Hospital, Mohamed V University, Rabat, Morocco
| | - Lalla Hasna Leghlimi
- Department of Cardiovascular anesthesia” B”, Ibn Sina University Hospital, Mohamed V University, Rabat, Morocco
| | - Aida Soufiani
- Department of Cardiology “A”, Ibn Sina University Hospital, Mohamed V University, Rabat, Morocco
| | - Nesma Bendagha
- Department of Cardiology “A”, Ibn Sina University Hospital, Mohamed V University, Rabat, Morocco
| | - Zineb Agoumy
- Department of Cardiology “A”, Ibn Sina University Hospital, Mohamed V University, Rabat, Morocco
| | - Samah Elmhadi
- Department of Cardiology “A”, Ibn Sina University Hospital, Mohamed V University, Rabat, Morocco
| | - Fadoua Lachhab
- Department of Cardiovascular surgery “B”, Ibn Sina University Hospital, Mohamed V University, Rabat, Morocco
| | - Lahcen Marmade
- Department of Cardiovascular surgery “B”, Ibn Sina University Hospital, Mohamed V University, Rabat, Morocco
| | - Said Moughil
- Department of Cardiovascular surgery “B”, Ibn Sina University Hospital, Mohamed V University, Rabat, Morocco
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4
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Kaur A, Kodra A, Thampi S, Goldberg Y, Kliger C. Percutaneous Treatment of a Left Ventricular Pseudoaneurysm Post-Aortic Valve Replacement. JACC Case Rep 2024; 29:102434. [PMID: 39157551 PMCID: PMC11328774 DOI: 10.1016/j.jaccas.2024.102434] [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: 06/23/2023] [Revised: 04/03/2024] [Accepted: 04/16/2024] [Indexed: 08/20/2024]
Abstract
Left ventricular outflow tract pseudoaneurysm is rare but serious complication after aortic valve replacement and may occur secondarily to endocarditis, suture dehiscence, or morphologic changes at the aortic annulus. We present a case of successful percutaneous closure of a left ventricular outflow tract pseudoaneurysm using various cardiovascular imaging modalities.
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Affiliation(s)
- Arpanjeet Kaur
- Department of Medicine, Icahn School of Medicine at Mount Sinai Morningside/West, New York, New York, USA
| | - Arber Kodra
- Division of Cardiology, Lenox Hill Hospital, New York, New York, USA
| | - Shankar Thampi
- Division of Cardiology, Lenox Hill Hospital, New York, New York, USA
| | - Ythan Goldberg
- Division of Cardiology, Lenox Hill Hospital, New York, New York, USA
| | - Chad Kliger
- Division of Cardiology, Lenox Hill Hospital, New York, New York, USA
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5
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Ruggerini S, Venturelli A, Tripodi AG, Brega C. Case report: pseudoaneurysm of left ventricle secondary to infective endocarditis complicated by cardiac rupture-a multimodality imaging approach. Eur Heart J Case Rep 2024; 8:ytae318. [PMID: 39006211 PMCID: PMC11244180 DOI: 10.1093/ehjcr/ytae318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Revised: 10/26/2023] [Accepted: 06/24/2024] [Indexed: 07/16/2024]
Abstract
Background Pseudoaneurysm (PSA) of the left ventricle (LV) is a rare peri-annular complication of infective endocarditis (IE), and it is associated with high risk of free wall rupture. The diagnosis is challenging because the exact incidence and the pathogenesis are still unclear. Case summary A 69-year-old lady underwent prosthetic mitral valve replacement for IE secondary to Staphylococcus aureus sepsis complicated by multiple embolizations. In the post-operative period, the patient developed persistent low-grade fever with negative blood culture. Transoesophageal echocardiography (TOE) revealed complete posterior valve detachment and a PSA sac arising from the antero-lateral commissure; the colour flow Doppler showed massive mitral regurgitation. Thoracic computed tomography (CT) scan confirmed the echo data and the exact localization of the cardiac rupture. The patient underwent reoperation, a pericardial patch was sutured to exclude the PSA sac, and a mechanical prosthesis valve was finally implanted. A follow-up TOE revealed the exclusion of the PSA; two leakages with mild peri-valvular mitral regurgitation were found, with no haemodynamic impact. Discussion In our case, the patient developed a PSA of the LV as a consequence of peri-annular extension of IE on the mitral valve. Pseudoaneurysm is a potentially lethal complication, if not promptly treated. Multimodality imaging including echocardiography and CT scan is recommended, in order to plan surgery ad hoc.
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Affiliation(s)
- Sara Ruggerini
- Cardiology Unit, Ospedale 'Ceccarini', Riccione (Rimini), Azienda USL della Romagna, Viale Frosinone, 7, Riccione, RN 47838, Italy
| | - Andrea Venturelli
- Cardiology Unit, Ospedale 'Ceccarini', Riccione (Rimini), Azienda USL della Romagna, Viale Frosinone, 7, Riccione, RN 47838, Italy
| | - Alberto Giovanni Tripodi
- Cardiovascular Department, Maria Cecilia Hospital, GVM Care & Research, Cotignola, Ravenna, Italy
| | - Carlotta Brega
- Cardiovascular Department, Maria Cecilia Hospital, GVM Care & Research, Cotignola, Ravenna, Italy
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6
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Arora GS, Kaur Gill T. Critical insights into the diagnosis and management of post-myocardial infarction left ventricular aneurysm of the inferior wall: a case report and brief review. Arch Med Sci Atheroscler Dis 2024; 9:e147-e151. [PMID: 39086616 PMCID: PMC11289232 DOI: 10.5114/amsad/189733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2024] [Accepted: 06/06/2024] [Indexed: 08/02/2024] Open
Affiliation(s)
| | - Tanveen Kaur Gill
- Sri Guru Ram Das Institute of Medical Science and Research, Amritsar, India
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7
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Hashimoto K, Yamamoto H, Harada A, Yamada H, Ikeda Y, Hashimoto T. Hypertrophic cardiomyopathy-related left ventricular pseudoaneurysm: A case report. Heliyon 2024; 10:e32197. [PMID: 38868059 PMCID: PMC11168430 DOI: 10.1016/j.heliyon.2024.e32197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Revised: 05/23/2024] [Accepted: 05/29/2024] [Indexed: 06/14/2024] Open
Abstract
Background Myocardial infarction-related left ventricular pseudoaneurysm (LVP), covered by the adjacent pericardial or scar tissue, is a fatal sequela of left ventricular rupture. Whereas hypertrophic cardiomyopathy (HCM) may cause left ventricular true aneurysm. Differentiating LVP from left ventricular true aneurysm is crucial because their natural histories and treatment strategies are distinct. However, the incidence and management of HCM-related LVP remain unknown. Case presentation An 88-year-old man was admitted to our hospital with sudden-onset chest pain. Upon initial examination, vital signs were stable, and a grade 4/6 systolic murmur was noted. An electrocardiogram revealed atrial fibrillation and poor R-wave progression without ST-T changes or negative T-waves. An echocardiography showed mild left ventricular hypertrophy, mid-ventricular obstruction with a significant intraventricular pressure gradient, left ventricular outflow tract obstruction, and a small left ventricular apical outpouching. Cardiac computed tomography angiography (CCTA) assisted in the diagnosis of LVP, and an accompanying pericardial effusion suggested impending cardiac rupture. Because the patient initially refused our proposed urgent surgery, medication was initiated with continuous hemodynamic monitoring in the intensive care unit; however, the patient's condition did not improve. During a semi-urgent surgical repair of the aneurysmal wall, LVP was observed and confirmed by pathology. Myocardial tissue adjacent to the pseudoaneurysm was consistent with that of HCM. Subsequently, a final diagnosis of HCM-related LVP was made. The postoperative course was notable for transient profound hypotension. Thereafter, the patient died of non-occlusive mesenteric ischemia on day 6. Conclusions To our knowledge, this is the first reported case of HCM-related LVP mimicking impending cardiac rupture. Our case highlights the importance of considering HCM-related LVP in patients with left ventricular outpouching and CCTA in the LVP diagnosis. In further research, data on the appropriate management of HCM-related LVP should be accumulated.
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Affiliation(s)
- Katsuya Hashimoto
- Department of Cardiovascular Medicine, Narita-Tomisato Tokushukai Hospital, Chiba, Japan
| | - Hiroyuki Yamamoto
- Department of Cardiovascular Medicine, Narita-Tomisato Tokushukai Hospital, Chiba, Japan
- Department of Cardiology, Tokyo Medical University Hospital, Tokyo, Japan
| | - Atsushi Harada
- Department of Cardiovascular Surgery, Narita-Tomisato Tokushukai Hospital, Chiba, Japan
| | - Hiroyuki Yamada
- Department of Cardiovascular Surgery, Narita-Tomisato Tokushukai Hospital, Chiba, Japan
| | - Yoshihiko Ikeda
- Department of Pathology, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Toru Hashimoto
- Department of Cardiovascular Medicine, Narita-Tomisato Tokushukai Hospital, Chiba, Japan
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8
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Lorusso R, Cubeddu RJ, Matteucci M, Ronco D, Moreno PR. Ventricular Pseudoaneurysm and Free Wall Rupture After Acute Myocardial Infarction: JACC Focus Seminar 4/5. J Am Coll Cardiol 2024; 83:1902-1916. [PMID: 38719370 DOI: 10.1016/j.jacc.2023.10.054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Revised: 10/12/2023] [Accepted: 10/24/2023] [Indexed: 07/16/2024]
Abstract
Postinfarction ventricular free-wall rupture is a rare mechanical complication, accounting for <0.01% to 0.02% of cases. As an often-catastrophic event, death typically ensues within minutes due to sudden massive hemopericardium resulting in cardiac tamponade. Early recognition is pivotal, and may allow for pericardial drainage and open surgical repair as the only emergent life-saving procedure. In cases of contained rupture with pseudo-aneurysm (PSA) formation, hospitalization with subsequent early surgical intervention is warranted. Not uncommonly, PSA may go unrecognized in asymptomatic patients and diagnosed late during subsequent cardiac imaging. In these patients, the unsettling risk of complete rupture demands early surgical repair. Novel developments, in the field of transcatheter-based therapies and multimodality imaging, have enabled percutaneous PSA repair as a feasible alternate strategy for patients at high or prohibitive surgical risk. Contemporary advancements in the diagnosis and treatment of postmyocardial infarction ventricular free-wall rupture and PSA are provided in this review.
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Affiliation(s)
- Roberto Lorusso
- Cardio-Thoracic Surgery Department, Maastricht University Medical Centre (MUMC), Maastricht, the Netherlands; Cardiovascular Research Institute Maastricht (CARIM), Maastricht, the Netherlands.
| | - Roberto J Cubeddu
- NCH Rooney Heart Institute, Section for Structural Heart Disease, NCH Healthcare System, Naples, Florida, USA; Igor Palacios Fellow Fouldation, Boston, Massachusetts, USA
| | - Matteo Matteucci
- Cardio-Thoracic Surgery Department, Maastricht University Medical Centre (MUMC), Maastricht, the Netherlands; Cardiovascular Research Institute Maastricht (CARIM), Maastricht, the Netherlands; Cardiac Surgery Unit, ASSTSette Laghi, Varese, Italy
| | - Daniele Ronco
- Cardio-Thoracic Surgery Department, Maastricht University Medical Centre (MUMC), Maastricht, the Netherlands; Cardiovascular Research Institute Maastricht (CARIM), Maastricht, the Netherlands; Cardiac Surgery Unit, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Pedro R Moreno
- Igor Palacios Fellow Fouldation, Boston, Massachusetts, USA; Mount Sinai Fuster Heart Hospital, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
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9
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Yamada R, Okamura H, Wada Y, Yamaguchi A. Surgical techniques using an attached patch for large left ventricular pseudoaneurysm after inferior acute myocardial infarction. INTERDISCIPLINARY CARDIOVASCULAR AND THORACIC SURGERY 2024; 38:ivae073. [PMID: 38637943 PMCID: PMC11181868 DOI: 10.1093/icvts/ivae073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Revised: 03/28/2024] [Accepted: 04/17/2024] [Indexed: 04/20/2024]
Abstract
We report a case of large left ventricular pseudoaneurysm after inferior acute myocardial infarction. Patch repair is commonly performed; however, only a few studies have described specific surgical techniques for left ventricular pseudoaneurysm repair of the inferior left ventricular wall. As an optimal repair technique for left ventricular pseudoaneurysm of the inferior left ventricular wall is lacking, we believe our technique is safe and effective in repairing this pathology.
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Affiliation(s)
- Ryotaro Yamada
- Department of Cardiovascular Surgery, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Homare Okamura
- Department of Cardiovascular Surgery, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Yohnosuke Wada
- Department of Cardiovascular Surgery, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Atsushi Yamaguchi
- Department of Cardiovascular Surgery, Saitama Medical Center, Jichi Medical University, Saitama, Japan
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10
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Zhang RS, Ro R, Bamira D, Vainrib A, Zhang L, Nayar AC, Saric M, Bernard S. Echocardiography in the Recognition and Management of Mechanical Complications of Acute Myocardial Infarction. Curr Cardiol Rep 2024; 26:393-404. [PMID: 38526749 DOI: 10.1007/s11886-024-02042-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/11/2024] [Indexed: 03/27/2024]
Abstract
PURPOSE OF REVIEW Although rare, the development of mechanical complications following an acute myocardial infarction is associated with a high morbidity and mortality. Here, we review the clinical features, diagnostic strategy, and treatment options for each of the mechanical complications, with a focus on the role of echocardiography. RECENT FINDINGS The growth of percutaneous structural interventions worldwide has given rise to new non-surgical options for management of mechanical complications. As such, select patients may benefit from a novel use of these established treatment methods. A thorough understanding of the two-dimensional, three-dimensional, color Doppler, and spectral Doppler findings for each mechanical complication is essential in recognizing major causes of hemodynamic decompensation after an acute myocardial infarction. Thereafter, echocardiography can aid in the selection and maintenance of mechanical circulatory support and potentially facilitate the use of a percutaneous intervention.
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Affiliation(s)
- Robert S Zhang
- Division of Cardiology, New York University Grossman School of Medicine, 550 First Avenue, New York, NY, 10016, USA
| | - Richard Ro
- Division of Cardiology, New York University Grossman School of Medicine, 550 First Avenue, New York, NY, 10016, USA
| | - Daniel Bamira
- Division of Cardiology, New York University Grossman School of Medicine, 550 First Avenue, New York, NY, 10016, USA
| | - Alan Vainrib
- Division of Cardiology, New York University Grossman School of Medicine, 550 First Avenue, New York, NY, 10016, USA
| | - Lily Zhang
- Division of Cardiology, New York University Grossman School of Medicine, 550 First Avenue, New York, NY, 10016, USA
| | - Ambika C Nayar
- Division of Cardiology, New York University Grossman School of Medicine, 550 First Avenue, New York, NY, 10016, USA
| | - Muhamed Saric
- Division of Cardiology, New York University Grossman School of Medicine, 550 First Avenue, New York, NY, 10016, USA
| | - Samuel Bernard
- Division of Cardiology, New York University Grossman School of Medicine, 550 First Avenue, New York, NY, 10016, USA.
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11
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Engel-Rodriguez A, Escabi-Mendoza J, Molina-Lopez VH, Engel-Rodriguez N, Tiru-Vega M. A Case of Left Ventricular Pseudoaneurysm as a Complication of Late-Presenting ST-Segment Elevation Myocardial Infarction. Cureus 2024; 16:e60026. [PMID: 38854241 PMCID: PMC11162561 DOI: 10.7759/cureus.60026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/09/2024] [Indexed: 06/11/2024] Open
Abstract
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.
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Affiliation(s)
| | - Jose Escabi-Mendoza
- Cardiovascular Disease, VA (Veterans Affairs) Caribbean Healthcare Systems, San Juan, PRI
| | | | | | - Marilee Tiru-Vega
- Internal Medicine, VA (Veterans Affairs) Caribbean Healthcare Systems, San Juan, PRI
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12
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Rumbinaitė E, Venckus V, Mamedov A, Jakuškaitė G, Bučius P, Dobilienė O, Žaliūnas R, Jakuška P, Benetis R. Anterior basal left ventricular pseudoaneurysm in a single vessel disease. Perfusion 2024; 39:849-853. [PMID: 36855313 PMCID: PMC11083744 DOI: 10.1177/02676591231160269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/02/2023]
Abstract
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.
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Affiliation(s)
- Eglė Rumbinaitė
- Department of Cardiology, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Vilius Venckus
- Department of Cardiac, Thoracic and Vascular Surgery, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Arslan Mamedov
- Department of Cardiac, Thoracic and Vascular Surgery, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Gabrielė Jakuškaitė
- Department of Cardiology, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Paulius Bučius
- Department of Cardiology, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Olivija Dobilienė
- Department of Cardiology, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Remigijus Žaliūnas
- Department of Cardiology, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Povilas Jakuška
- Department of Cardiac, Thoracic and Vascular Surgery, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Rimantas Benetis
- Department of Cardiac, Thoracic and Vascular Surgery, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania
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13
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Barforoshi S, Shekar C, Yu Z, Liu E, Manubolu V, Budoff MJ, Roy SK. A Leaky False Pouch: Left Ventricle Pseudoaneurysm with Active Hemopericardium Detected on Cardiac Computed Tomography Angiography. CLINICAL MEDICINE INSIGHTS-CARDIOLOGY 2024; 18:11795468241249059. [PMID: 38686315 PMCID: PMC11057338 DOI: 10.1177/11795468241249059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Accepted: 04/03/2024] [Indexed: 05/02/2024]
Abstract
Pseudoaneurysm is a rare but fatal complication of myocardial infarction (MI). With the advances in cardiovascular disease detection and treatments, fatal structural complications post-MI are now rare. When they occur, advanced diagnostic modalities can be used for early diagnosis, aiding surgical planning, and improving prognosis. In our case, post-MI left ventricle pseudoaneurysm complicated by hemopericardium was diagnosed using cardiac computed tomography angiography (CCTA). Use of attenuation measurement on CCTA helped diagnose active extravasation into the hemopericardium. This case highlights the high index of suspicion needed for rare but fatal complications post-MI and the utility of CCTA in their management.
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Affiliation(s)
- Shiva Barforoshi
- Department of Medicine, Harbor-UCLA Medical Center, Torrance, CA, USA
| | - Chandana Shekar
- Lundquist Institute, Harbor-UCLA Medical Center, Torrance, CA, USA
| | - Zoe Yu
- Lundquist Institute, Harbor-UCLA Medical Center, Torrance, CA, USA
| | - Eugene Liu
- Lundquist Institute, Harbor-UCLA Medical Center, Torrance, CA, USA
| | - Venkat Manubolu
- Lundquist Institute, Harbor-UCLA Medical Center, Torrance, CA, USA
| | - Matthew J Budoff
- Lundquist Institute, Harbor-UCLA Medical Center, Torrance, CA, USA
| | - Sion K Roy
- Lundquist Institute, Harbor-UCLA Medical Center, Torrance, CA, USA
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14
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Wershing K, Colon J, Alegria J, Paolillo J, Wallihan D, Schwartz M. Left Ventricular Pseudoaneurysm in an Adult With a Repaired Partial Atrioventricular Canal Defect. CASE (PHILADELPHIA, PA.) 2024; 8:174-179. [PMID: 38524982 PMCID: PMC10954580 DOI: 10.1016/j.case.2023.12.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 03/26/2024]
Abstract
•LV pseudoaneurysm formation is rare after congenital heart disease repair. •Conservative management of LV pseudoaneurysm was successful in this unique case. •CCT and 3D printing are valuable in the characterization of LV pseudoaneurysm.
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Affiliation(s)
- Kathryn Wershing
- Department of Pediatrics, Levine Children’s Hospital, Atrium Health, Charlotte, North Carolina
| | - Joseb Colon
- Congenital Cardiac 3D Printing Program, Levine Children’s Hospital, Atrium Health, Charlotte, North Carolina
| | - Jorge Alegria
- Adult Congenital Heart Disease Program, Sanger Heart and Vascular Institute, Atrium Health, Charlotte, North Carolina
| | - Joseph Paolillo
- Adult Congenital Heart Disease Program, Sanger Heart and Vascular Institute, Atrium Health, Charlotte, North Carolina
- Division of Pediatric Cardiology, Levine Children’s Hospital, Atrium Health, Charlotte, North Carolina
| | - Daniel Wallihan
- Division of Radiology, Levine Children’s Hospital, Atrium Health, Charlotte, North Carolina
| | - Matthew Schwartz
- Adult Congenital Heart Disease Program, Sanger Heart and Vascular Institute, Atrium Health, Charlotte, North Carolina
- Division of Pediatric Cardiology, Levine Children’s Hospital, Atrium Health, Charlotte, North Carolina
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15
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Mima H, Mizote I, Nakamura D, Miyagawa S, Sakata Y. Coronary Computed Tomography Angiography to Diagnose a Large Left Ventricular Pseudoaneurysm That Formed Rapidly After Myocardial Infarction. Circ J 2024; 88:436. [PMID: 38246649 DOI: 10.1253/circj.cj-23-0906] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2024]
Affiliation(s)
- Hibiki Mima
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine
| | - Isamu Mizote
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine
| | - Daisuke Nakamura
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine
| | - Shigeru Miyagawa
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine
| | - Yasushi Sakata
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine
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16
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Parihar M, Mukhedkar S, Bhagwat A. Percutaneous device closure of left ventricular pseudoaneurysm: a rare case. ASIAINTERVENTION 2024; 10:36-37. [PMID: 38425807 PMCID: PMC10900239 DOI: 10.4244/aij-d-22-00073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Accepted: 09/15/2023] [Indexed: 03/02/2024]
Affiliation(s)
| | - Sachin Mukhedkar
- Department of Cardiology, Kamalnayan Bajaj Hospital, Aurangabad, Maharashtra, India
| | - Ajit Bhagwat
- Department of Cardiology, Kamalnayan Bajaj Hospital, Aurangabad, Maharashtra, India
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17
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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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18
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Izekor BE, Lovelace J, Giang TK, Ebert E, Olsovsky G. Idioventricular Rhythm: A Rare Presentation of Left Ventricular Pseudoaneurysm Following Radiofrequency Ablation. Cureus 2024; 16:e55272. [PMID: 38558650 PMCID: PMC10981548 DOI: 10.7759/cureus.55272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/29/2024] [Indexed: 04/04/2024] Open
Abstract
Left ventricular pseudoaneurysm (PsA) is a rare complication of radiofrequency ablation (RFA) of cardiac arrhythmias. Presentation can vary widely in terms of timeline, signs, and symptoms. Idioventricular rhythm is a rare presentation of PsA post-ablation. No cases of post-ablation PsA presenting with idioventricular rhythm have been reported in the literature to date. A 72-year-old male presented with symptomatic idioventricular rhythm 34 days post RFA for premature ventricular complexes (PVCs). A PsA involving the distal anterolateral of his left ventricle wall was identified on transthoracic echo and computed tomography (CT). This patient underwent surgical patch repair which resolved his ventricular arrhythmia.
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Affiliation(s)
- Bright E Izekor
- Cardiology, Baylor Scott & White Medical Center - Temple, Temple, USA
| | - Jessica Lovelace
- Internal Medicine, Baylor Scott & White Medical Center - Temple, Temple, USA
| | - Thao K Giang
- Internal Medicine, Baylor Scott & White Medical Center - Temple, Temple, USA
| | - Elizabeth Ebert
- Cardiology, Baylor Scott & White Medical Center - Temple, Temple, USA
| | - Gregory Olsovsky
- Electrophysiology, Baylor Scott & White Medical Center - Temple, Temple, USA
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19
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Singh S, Kaur J, Basnet A, Jayanti R, Malik BA. Left Ventricular Pseudoaneurysm: A Rare but Fatal Complication of Myocardial Infarction. Cureus 2024; 16:e51480. [PMID: 38298290 PMCID: PMC10830149 DOI: 10.7759/cureus.51480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/01/2024] [Indexed: 02/02/2024] Open
Abstract
Left ventricular pseudoaneurysm is a ventricular free wall rupture contained within the adjacent adherent pericardium or scar tissue. Myocardial infarction (MI), cardiac surgery, and chest trauma are the common causes. The most common presenting symptoms of pseudoaneurysms are congestive heart failure, chest pain, and dyspnea, but a small percentage of patients may be asymptomatic. Early diagnosis and treatment are of prime importance because of the tendency of pseudoaneurysms to expand and rupture, with a high mortality rate, especially if left untreated. We present a case of a 65-year-old man who was found to have left ventricular pseudoaneurysm on a follow-up echocardiography within three weeks of an MI. He subsequently underwent patch repair and was discharged after medical optimization. Our case highlights the importance of maintaining a high clinical suspicion of pseudoaneurysm in a patient post-MI, as delayed diagnosis and treatment can be fatal.
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Affiliation(s)
| | - Jasveen Kaur
- Internal Medicine, Maimonides Medical Center, Brooklyn, USA
| | - Arjun Basnet
- Internal Medicine, Maimonides Medical Center, Brooklyn, USA
| | - Ravi Jayanti
- Cardiology, Maimonides Medical Center, Brooklyn, USA
| | - Bilal A Malik
- Cardiology, Maimonides Medical Center, Brooklyn, USA
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20
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Kurdi M, Baranga L, Singh R, Scott J. Left ventricular pseudoaneurysm as a complication of LVAD explant. Radiol Case Rep 2024; 19:234-238. [PMID: 38028297 PMCID: PMC10630764 DOI: 10.1016/j.radcr.2023.10.022] [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: 08/26/2023] [Revised: 09/29/2023] [Accepted: 10/06/2023] [Indexed: 12/01/2023] Open
Abstract
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.
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Affiliation(s)
- Mohanad Kurdi
- Kings County Hospital Center, 451 Clarkson Ave, Brooklyn, NY 11203 USA
- SUNY Downstate Medical Center, 450 Clarkson Ave, Brooklyn, NY 11203 USA
| | - Latika Baranga
- Kings County Hospital Center, 451 Clarkson Ave, Brooklyn, NY 11203 USA
- SUNY Downstate Medical Center, 450 Clarkson Ave, Brooklyn, NY 11203 USA
| | - Rohindeep Singh
- Kings County Hospital Center, 451 Clarkson Ave, Brooklyn, NY 11203 USA
- SUNY Downstate Medical Center, 450 Clarkson Ave, Brooklyn, NY 11203 USA
| | - Jinel Scott
- Kings County Hospital Center, 451 Clarkson Ave, Brooklyn, NY 11203 USA
- SUNY Downstate Medical Center, 450 Clarkson Ave, Brooklyn, NY 11203 USA
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21
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Alexander G, Ashwath ML. Cardiac pseudoaneurysms: a clinical case series. Eur Heart J Case Rep 2024; 8:ytad636. [PMID: 38213869 PMCID: PMC10783806 DOI: 10.1093/ehjcr/ytad636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2023] [Revised: 12/10/2023] [Accepted: 12/18/2023] [Indexed: 01/13/2024]
Abstract
Background Cardiac pseudoaneurysms are a potentially life-threatening pathology with a variety of non-specific clinical manifestations. This case series uniquely shares a collection of rare pathologies with differing preceding risk factors and presentations, with an emphasis on the utility of multi-modality imaging in diagnosis and management. Case summary We present three cases of cardiac pseudoaneurysms. Case 1 is a 27-year-old woman with delayed presentation of a traumatic left ventricular pseudoaneurysm (LVP). Case 2 is a 73-year-old man with post-myocardial infarction LVP. Case 3 is a 38-year-old man with left ventricular outflow tract pseudoaneurysm after aortic valve replacement. Discussion Cardiac pseudoaneurysms are rare and important to diagnose in a timely manner. Advances in non-invasive imaging modalities have improved our ability to distinguish pseudoaneurysms from other pathologies, leading to more timely management.
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Affiliation(s)
- Grace Alexander
- Department of Internal Medicine, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
| | - Mahi L Ashwath
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Iowa Hospitals and Clinics, 200 Hawkins Dr, Iowa City, IA 52242, USA
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22
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Machii Y, Taoka M, Hayashi Y, Harada A, Kamata K, Tanaka M. Delayed Giant Pseudoaneurysm With Left-to-Right Shunt Following Postinfarct Ventricular Septal Perforation Repair. Tex Heart Inst J 2023; 50:e238269. [PMID: 38073437 PMCID: PMC10751473 DOI: 10.14503/thij-23-8269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Abstract
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.
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Affiliation(s)
- Yojiro Machii
- Department of Cardiovascular Surgery, Nihon University School of Medicine, Tokyo, Japan
| | - Makoto Taoka
- Department of Cardiovascular Surgery, Nihon University School of Medicine, Tokyo, Japan
| | - Yuki Hayashi
- Department of Cardiovascular Surgery, Nihon University School of Medicine, Tokyo, Japan
| | - Atsushi Harada
- Department of Cardiovascular Surgery, Nihon University School of Medicine, Tokyo, Japan
| | - Keita Kamata
- Department of Cardiovascular Surgery, Nihon University School of Medicine, Tokyo, Japan
| | - Masashi Tanaka
- Department of Cardiovascular Surgery, Nihon University School of Medicine, Tokyo, Japan
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23
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Katahira R, Sano H, Tanimura K, Okita Y. Cardiac rupture during the course of treatment for acute purulent pericarditis caused by Staphylococcus aureus: a case report. Eur Heart J Case Rep 2023; 7:ytad584. [PMID: 38025118 PMCID: PMC10681738 DOI: 10.1093/ehjcr/ytad584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2023] [Revised: 11/04/2023] [Accepted: 11/16/2023] [Indexed: 12/01/2023]
Abstract
Background Purulent pericarditis is rare in the modern era of antibiotics. However, it is a rapidly progressive, life-threatening disease with complications, including cardiac tamponade and left ventricular pseudoaneurysm. Case summary A 44-year-old female was admitted with a pontine haemorrhage. On the 25th day of admission, she developed a fever along with chest pain and dyspnoea. Transthoracic echocardiography and computed tomography revealed a large pericardial effusion, leading to the diagnosis of cardiac tamponade. Pericardiocentesis was performed, resulting in the drainage of 750 mL of blood-stained fluid. Blood and pericardial fluid cultures were positive for Staphylococcus aureus; therefore, ceftriaxone was administered. On the 49th day, she became febrile again, and computed tomography showed increased pericardial effusion. Transthoracic echocardiography confirmed the large pericardial effusion and revealed a pseudoaneurysm on the inferior of the left ventricular wall, with blood flowing from the pseudoaneurysm into the pericardial space. Urgent surgical intervention was performed to repair a myocardial defect as a left ventricular pseudoaneurysm had ruptured in the pericardium. The patient recovered and was transferred to another hospital for rehabilitation after 108 days of hospitalization. Discussion Purulent pericarditis can be a lethal complication; therefore, careful follow-up and strict adherence to therapeutic strategies, including the use of imaging technologies such as echocardiography, are important.
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Affiliation(s)
- Ryutaro Katahira
- Division of Cardio-Aortic Center, Department of Internal Medicine, Takatsuki General Hospital, 1-3-13 Kosobe-cho, Takatsuki 569-1123, Japan
| | - Hiroyuki Sano
- Division of Cardio-Aortic Center, Department of Internal Medicine, Takatsuki General Hospital, 1-3-13 Kosobe-cho, Takatsuki 569-1123, Japan
| | - Kosuke Tanimura
- Division of Cardio-Aortic Center, Department of Internal Medicine, Takatsuki General Hospital, 1-3-13 Kosobe-cho, Takatsuki 569-1123, Japan
| | - Yutaka Okita
- Division of Cardio-Aortic Center, Department of Surgery, Takatsuki General Hospital, Takatsuki, Japan
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24
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Carolino D'Araujo S, El-Mourad M. Coronary artery compression by left ventricular pseudoaneurysm - clinical case report. Acta Cardiol 2023; 78:961-963. [PMID: 37078592 DOI: 10.1080/00015385.2022.2161741] [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: 06/01/2022] [Accepted: 12/16/2022] [Indexed: 04/21/2023]
Affiliation(s)
| | - Mike El-Mourad
- Department of Cardiology, Erasme University Hospital, Brussels, Belgium
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25
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Liu Y, Cai Z, Xu L, Zheng Y, Chen M, Dong N, Chen S. Concomitant valve surgery is associated with worse outcomes in surgical treatments of post-infarction ventricular aneurysm. Front Cardiovasc Med 2023; 10:1194374. [PMID: 37655215 PMCID: PMC10465797 DOI: 10.3389/fcvm.2023.1194374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Accepted: 07/24/2023] [Indexed: 09/02/2023] Open
Abstract
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.
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Affiliation(s)
| | | | | | | | | | - Nianguo Dong
- Department of Cardiovascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Si Chen
- Department of Cardiovascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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26
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Vyas R, El-Hajj S. Percutaneous Closure of an Apical Left Ventricular Pseudoaneurysm. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2023; 53S:S159-S162. [PMID: 35918252 DOI: 10.1016/j.carrev.2022.07.012] [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: 03/07/2022] [Revised: 07/10/2022] [Accepted: 07/20/2022] [Indexed: 11/29/2022]
Affiliation(s)
- Rohit Vyas
- Division of Cardiovascular Medicine, University of Toledo, Toledo, OH, USA.
| | - Stephanie El-Hajj
- Division of Cardiovascular Medicine, ProMedica Toledo Hospital, Toledo, OH, USA
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27
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Tiruneh AG, Bekele A, Asrat Y, Tsegaye Q, Tesfaye W, Bezabih A. Successful repair of left ventricular rupture with pseudoaneurysm: a case report. J Surg Case Rep 2023; 2023:rjad444. [PMID: 37560604 PMCID: PMC10409564 DOI: 10.1093/jscr/rjad444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Accepted: 07/18/2023] [Indexed: 08/11/2023] Open
Abstract
Ventricular rupture with pseudoaneurysm is a rare phenomenon that usually occurs after myocardial infarction, previous cardiac surgery and infectious or inflammatory conditions. To prevent rupture of the pseudoaneurysm, urgent repair is recommended. We report successful open surgical repair of a 46-year-old man, who presented with pseudoaneurysm communicating with left ventricle.
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Affiliation(s)
- Abraham G Tiruneh
- College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Admikew Bekele
- College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Yidnekachew Asrat
- College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Qaleab Tsegaye
- College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Workneh Tesfaye
- College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Abebe Bezabih
- College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
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28
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Todd ML, Eppurath A, Shoela R. Prosthetic Mitral Valve Endocarditis Complicated by Left Ventricular Pseudoaneurysm. Cureus 2023; 15:e40513. [PMID: 37461768 PMCID: PMC10350292 DOI: 10.7759/cureus.40513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/16/2023] [Indexed: 07/20/2023] Open
Abstract
Left ventricular pseudoaneurysm is a rare complication that can result from mitral valve replacement. Proper follow-up imaging can help to detect this potentially fatal complication and identify areas of concern. Infective endocarditis following mitral valve replacement can occur and further lead to the development of a pseudoaneurysm. We describe a case of left ventricular aneurysm in the setting of infective endocarditis following mitral valve replacement and present radiologic images from various modalities detailing the major findings.
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Affiliation(s)
- Maxwell L Todd
- Radiology, Saint Louis University School of Medicine, St. Louis, USA
| | - Atul Eppurath
- Radiology, Saint Louis University School of Medicine, St. Louis, USA
| | - Ramy Shoela
- Radiology, Saint Louis University School of Medicine, St. Louis, USA
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29
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Gumrai P, Na-Nan K, Tepsuwan T, Suwannasom P, Louthrenoo W. Cardiac wall rupture in systemic lupus erythematosus: a case report and review of the literature. Clin Rheumatol 2023:10.1007/s10067-023-06614-8. [PMID: 37140686 DOI: 10.1007/s10067-023-06614-8] [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: 03/02/2023] [Revised: 04/05/2023] [Accepted: 04/26/2023] [Indexed: 05/05/2023]
Abstract
Cardiac wall rupture (CWR) is a serious and often fatal complication of myocardial infarction (MI). Despite an increase in the incidence of MI in patients with systemic lupus erythematosus (SLE), cases of CWR in these patients have been reported rarely. This study reports an SLE patient with CWR and pseudoaneurysm formation and reviews previously reported cases of CWR in SLE patients. An English language literature review of from the PubMed, EMBASE, and Scopus databases on published cases of CWR in SLE, up until January 2023, was performed and analyzed. The search identified 4 patients, including the present one, 5 cases altogether. All of them were female aged 27-40 years, and 3 of them had had SLE for 10 years or more. Chest pain and dyspnea were the common presentations. All had left ventricular (LV) wall rupture. Three patients had LV wall rupture with pseudoaneurysm formation (one had MI with normal coronary artery, one myocardial necrosis secondary from small coronary artery vasculitis and one MI from uncertain cause). The other 2 patients had LV free wall rupture (one had MI with extensive coronary atherosclerosis with coronary arteritis, and the other septic myocarditis with septic coronary arteritis) and these 2 patients died before the diagnosis was made. Three patients with pseudoaneurysm received surgical correction with good clinical outcomes in all. Cardiac wall rupture is a serious and often fatal cardiac complication. Emergency diagnosis and appropriate management with an experienced cardiology team is crucial. Surgical correction is the treatment of choice. Key Points • Cardiac wall rupture, a serious and often fatal cardiac complication, has rarely been described in SLE patients. • Emergency diagnosis and appropriate management with an experienced cardiology team is crucial. Surgical correction is the treatment of choice.
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Affiliation(s)
- Pawut Gumrai
- Division of Cardiology, Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Kittiya Na-Nan
- Division of Rheumatology, Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Thitipong Tepsuwan
- Division of Cardiothoracic Surgery, Department of Surgery, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Pannipa Suwannasom
- Division of Cardiology, Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Worawit Louthrenoo
- Division of Rheumatology, Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand.
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30
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Naguib M, Elsayed M, Khouzam RN, Iskander A. Percutaneous Closure of Post-Infarct Left Ventricular Pseudoaneurysm; A Review of Literature. Curr Probl Cardiol 2023; 48:101743. [PMID: 37084993 DOI: 10.1016/j.cpcardiol.2023.101743] [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: 04/08/2023] [Accepted: 04/14/2023] [Indexed: 04/23/2023]
Abstract
Left ventricular pseudoaneurysm is a well-known complication of myocardial infarction and open-heart surgery and has recently been described as succeeding transapical transcatheter aortic valve replacement (TAVR). While surgical intervention is the conventional therapeutic approach, transcatheter closure can be considered in patients at high risk for surgical procedures. In this article, we present a post-myocardial infarction pseudoaneurysm for which closure was done via retrograde left ventricular (LV) access using an Amplatzer Septal Occluder, and provide a review of recent literature focusing on indications and outcomes of the different percutaneous techniques and devices.
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Affiliation(s)
- M Naguib
- Bachelor of Medicine and Bachelor of Surgery and Bachelor of Obstetrics, Roayl college of Surgeons in Ireland & North Lincolnshire and Goole NHS Trust Junior doctor.
| | - M Elsayed
- Bachelor of Medicine and Bachelor of Surgery and Bachelor of Obstetrics, Roayl college of Surgeons in Ireland & Southport at Osmskirk district hospital NHS Junior doctor
| | - R N Khouzam
- Consultant Interventional Cardiologist, Methodist Health Care
| | - A Iskander
- Doctor of Medicine, Consultant Interventional Cardiologist, St. Joseph's Hospital Cardiology Associates, St. Joseph's Health Hospital
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31
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Naseerullah FS, Pyle W, Addai T, Murthy A. Left ventricular pseudoaneurysm without antecedent myocardial infarction. J Cardiol Cases 2023. [DOI: 10.1016/j.jccase.2023.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2023] Open
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32
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Nguyen EK, Suksaranjit P, Bashir MA, Firchau DJ, Gebska MA. Decoding Postinfarction Left Ventricular Pseudoaneurysm. JACC Case Rep 2023; 9:101533. [PMID: 36909267 PMCID: PMC9998713 DOI: 10.1016/j.jaccas.2022.07.005] [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: 04/18/2022] [Revised: 06/28/2022] [Accepted: 07/04/2022] [Indexed: 11/06/2022]
Abstract
Recognizing true from pseudo left ventricular aneurysm after myocardial infarction is paramount to guide clinical management and determine need for surgical urgency. We discuss a case of a postinfarction pseudoaneurysm that poses unique anatomic challenges and may hold a secret "DaVinci code" beyond current diagnostic criteria. (Level of Difficulty: Advanced.).
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Affiliation(s)
- Emily K Nguyen
- Department of Internal Medicine, Carver College of Medicine, University of Iowa, Iowa City, Iowa, USA
| | - Promporn Suksaranjit
- Division of Cardiovascular Medicine, Carver College of Medicine, University of Iowa, Iowa City, Iowa, USA
| | - Mohammad A Bashir
- Division of Cardiothoracic Surgery, Carver College of Medicine, University of Iowa, Iowa City, Iowa, USA
| | - Dennis J Firchau
- Department of Pathology, Carver College of Medicine, University of Iowa, Iowa City, Iowa, USA
| | - Milena A Gebska
- Division of Cardiovascular Medicine, Carver College of Medicine, University of Iowa, Iowa City, Iowa, USA
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Kasai Y, Kasai J, Kitai T, Morita J, Fujita T. Iatrogenic Left Ventricular Pseudoaneurysm After Successful Radiofrequency Catheter Ablation for Premature Ventricular Contraction Originating From the Posterior Papillary Muscles. Circ J 2023; 87:464. [PMID: 36504082 DOI: 10.1253/circj.cj-22-0553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- Yuhei Kasai
- Department of Cardiology, Sapporo Cardio Vascular Clinic
| | | | - Takayuki Kitai
- Department of Cardiology, Sapporo Cardio Vascular Clinic
| | - Junji Morita
- Department of Cardiology, Sapporo Cardio Vascular Clinic
| | - Tsutomu Fujita
- Department of Cardiology, Sapporo Cardio Vascular Clinic
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Krenz J, Flottmann C, Faber L. [74-year-old patient with recurrent cardiac decompensation after anterior myocardial infarction]. Dtsch Med Wochenschr 2023; 148:75-76. [PMID: 36690002 DOI: 10.1055/a-1964-5345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Affiliation(s)
- Jonas Krenz
- Medizinische Klinik 2, Lukas-Krankenhaus Bünde
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35
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Abdelhaleem A, Leung A, Nguyen J, Schapiro W, Khalique O, Bercow N, Cao JJ, Kadiyala M. Left ventricular aneurysm versus pseudoaneurysm: Diagnosis in the era of multi-modality imaging and 3D-printing. Echocardiography 2023; 40:137-142. [PMID: 36647761 DOI: 10.1111/echo.15523] [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: 09/11/2022] [Revised: 12/09/2022] [Accepted: 12/23/2022] [Indexed: 01/18/2023] Open
Abstract
In this case report, we illustrate the contemporary use of multi-modality cardiac imaging and three-dimensional (3D)-printing in the diagnosis and precise surgical planning of a large ventricular aneurysm with an extensive thrombus burden after myocardial infarction. We further discuss an integrated multimodality approach in the evaluation of ventricular outpouchings.
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Affiliation(s)
- Ahmed Abdelhaleem
- Cardiology Division, Heart and Vascular Institute, West Virginia University, Morgantown, West Virginia, USA
| | - Amanda Leung
- Cardiology Division, Saint, Francis Hospital and Heart Center, New York, USA
| | - James Nguyen
- Cardiology Division, AdventHealth Orlando, Orlando, Florida, USA
| | - William Schapiro
- Cardiology Division, Saint, Francis Hospital and Heart Center, New York, USA
| | - Omar Khalique
- Cardiology Division, Saint, Francis Hospital and Heart Center, New York, USA
| | - Neil Bercow
- Cardiac Surgery Division, Saint Francis Hospital and Heart Center, New York, USA
| | - Jie J Cao
- Cardiology Division, Saint, Francis Hospital and Heart Center, New York, USA
| | - Madhavi Kadiyala
- Cardiology Division, Heart and Vascular Institute, West Virginia University, Morgantown, West Virginia, USA
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El Hadj Sidi C, Isselmou V, Mohamed Ahmed MF, Diop EHA, Argueina TE, Mady H, Boye K. Pseudoaneurysm of the left ventricular free wall occurring after cardiac surgery of endocarditis affecting mitral and aortic valves: a case report. Egypt Heart J 2023; 75:6. [PMID: 36692801 PMCID: PMC9873888 DOI: 10.1186/s43044-023-00334-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Accepted: 01/14/2023] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND Infective endocarditis remains a serious condition. Left ventricular pseudoaneurysm may complicate the clinical course of infective endocarditis or occur postoperatively. CASE PRESENTATION We describe a case of a pseudoaneurysm of the left ventricular lateral wall which developed one month following cardiac surgery of active endocarditis affecting aortic and mitral valves. The diagnosis was established by transthoracic echocardiography and computed tomography angiography of the chest. Urgent cardiac surgery is performed with excision of the pseudoaneurysm and direct closure of the defect. The patient had a complete recovery and was discharged on the twelfth postoperative day. CONCLUSIONS Left ventricular pseudoaneurysms are rare but potentially fatal. The symptoms revealing such complications are very diverse. Surgical treatment can be offered to younger patients.
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Affiliation(s)
- Chighaly El Hadj Sidi
- Department of Cardiovascular and Thoracic Surgery, National Center of Cardiology, Nouakchott, Mauritania.
| | - Varha Isselmou
- Department of Cardiology, National Center of Cardiology, Nouakchott, Mauritania
| | | | - El Hadj Abdelaziz Diop
- Department of Cardiovascular and Thoracic Surgery, National Center of Cardiology, Nouakchott, Mauritania
| | - Taleb Ekhyar Argueina
- Department of Cardiovascular and Thoracic Surgery, National Center of Cardiology, Nouakchott, Mauritania
| | - Haimouda Mady
- Department of Cardiovascular and Thoracic Surgery, National Center of Cardiology, Nouakchott, Mauritania
| | - Khaled Boye
- Department of Cardiovascular and Thoracic Surgery, National Center of Cardiology, Nouakchott, Mauritania
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Pirzada A, Styles K, Stewart R. Massive left ventricular pseudoaneurysm presenting as dysphagia: a case report. Eur Heart J Case Rep 2023; 7:ytac495. [PMID: 36727138 PMCID: PMC9879834 DOI: 10.1093/ehjcr/ytac495] [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: 04/06/2022] [Revised: 04/26/2022] [Accepted: 12/30/2022] [Indexed: 01/04/2023]
Abstract
Background Left ventricular pseudoaneurysm is a recognized, however, uncommon presentation of acute myocardial infarction in the current era. This is due to early reperfusion therapy for acute myocardial infarction. Left ventricular pseudoaneurysm after myocardial infarction can present in a variety of ways, including heart failure, chest pain, and dyspnoea. Case summary We present a case of a 61-year-old male who presented with extremely atypical symptoms of dysphagia and weight loss due to a massive left ventricular pseudoaneurysm. Transthoracic echocardiogram and computed tomography revealed a large pseudoaneurysm causing mass effect on multiple gastrointestinal organs. Organic causes for dysphagia and weight loss were ruled out by gastroscopy. Surgical management was carried out but was ultimately unsuccessful. Discussion Despite the heterogeneity in presentation for patients with left ventricular pseudoaneurysm, rapid diagnosis is important for management and prognosis. Diagnostic tools include transthoracic echocardiography, computed tomography, and cardiac magnetic resonance imaging. Management is usually surgical; however, there is some debate in the literature regarding conservative vs. surgical management for chronic pseudoaneurysms. More data are needed to determine optimal management strategies and prognosis for patients with left ventricular pseudoaneurysms.
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Affiliation(s)
- Ashar Pirzada
- Corresponding author. Tel: +1 902 473 7044, Fax: +1 902 473 2434,
| | - Kim Styles
- Division of Cardiology, Department of Medicine, Dalhousie University, 1796 Summer St, Room 2132, Halifax Infirmary, Halifax, NS B3H 3A7, Canada
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38
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Bakhutashvili Z, Janelidze L, Beria K, Bakashvili N, Kuridze N. Left ventricular pseudoaneurysmectomy in patient without hemodynamic instability: A case report. Clin Case Rep 2023; 11:e6855. [PMID: 36694640 PMCID: PMC9842869 DOI: 10.1002/ccr3.6855] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2022] [Revised: 01/02/2023] [Accepted: 01/04/2023] [Indexed: 01/18/2023] Open
Abstract
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.
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Affiliation(s)
- Zviad Bakhutashvili
- Department of Cardiac SurgeryG. Chapidze Emergency Cardiology CenterTbilisiGeorgia
| | - Lia Janelidze
- Department of Cardiac SurgeryG. Chapidze Emergency Cardiology CenterTbilisiGeorgia
| | - Kakhaber Beria
- Department of Cardiac SurgeryG. Chapidze Emergency Cardiology CenterTbilisiGeorgia
| | - Nana Bakashvili
- Department of Cardiac SurgeryG. Chapidze Emergency Cardiology CenterTbilisiGeorgia
| | - Nika Kuridze
- Department of Cardiac SurgeryG. Chapidze Emergency Cardiology CenterTbilisiGeorgia
- Faculty of Clinical and Translational MedicineIvane Javakhishvili Tbilisi State UniversityTbilisiGeorgia
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Rakha S, Elgamal MAF, Sobh DM, Elmarsafawy H. Left Ventricular Pseudoaneurysm: Unexpected Sequel of Tamponade-Complicated Infectious Pericarditis in Infancy. World J Pediatr Congenit Heart Surg 2023; 14:98-102. [PMID: 36214749 DOI: 10.1177/21501351221129984] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Left ventricular pseudoaneurysm (LV-PsA) is a critical finding that could result in a fatal outcome. It may complicate myocardial infarction, cardiac surgery, trauma, or endocarditis but rarely follows pericarditis. We report a case of infectious pericarditis complicated by pericardial tamponade in an infant. After effusion drainage and medical therapy, a large LV-PsA was detected. Successful closure of the pseudoaneurysm᾽s neck was accomplished using a Gore-tex patch.
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Affiliation(s)
- Shaimaa Rakha
- Pediatric Cardiology Unit, Department of Pediatrics, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Mohamed-Adel F Elgamal
- Pediatric Cardiac Surgery Unit, Mansoura University Children's Hospital, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Donia M Sobh
- Department of Diagnostic and Interventional Radiology, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Hala Elmarsafawy
- Pediatric Cardiology Unit, Department of Pediatrics, Faculty of Medicine, Mansoura University, Mansoura, Egypt.,68780Faculty of Medicine, New Mansoura University, New Mansoura, Egypt
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40
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Fishberger G, Bulard B, Lozonschi L. A Dual Atrioventricular Approach to Repair Pseudoaneurysm after Mitral Valve Surgery. Thorac Cardiovasc Surg Rep 2023; 12:e28-e32. [PMID: 37223106 PMCID: PMC10202565 DOI: 10.1055/s-0043-1769007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2023] [Accepted: 03/22/2023] [Indexed: 05/25/2023] Open
Abstract
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.
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Affiliation(s)
- Gregory Fishberger
- Division of Cardiothoracic Surgery, Department of Surgery, University of South Florida Morsani College of Medicine, Tampa, Florida, United States
| | - Blake Bulard
- Division of Cardiothoracic Surgery, Department of Surgery, University of South Florida Morsani College of Medicine, Tampa, Florida, United States
| | - Lucian Lozonschi
- Division of Cardiothoracic Surgery, Department of Surgery, University of South Florida Morsani College of Medicine, Tampa, Florida, United States
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41
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Oluleye O, Danielson D, Lowrie A, Brown J, Lien R. Transthoracic Echocardiography for Diagnosis of Infective Endocarditis Causing Late Left Ventricular Pseudoaneurysm of the Basal Anterolateral Wall. CASE 2022; 7:96-100. [PMID: 37065835 PMCID: PMC10102988 DOI: 10.1016/j.case.2022.11.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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42
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Nishiori H, Matsumiya G. Left ventricular pseudoaneurysm secondary to recurrent mitral prosthetic valve endocarditis. Clin Case Rep 2022; 10:e6522. [PMID: 36348986 PMCID: PMC9634262 DOI: 10.1002/ccr3.6522] [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: 08/10/2022] [Revised: 09/21/2022] [Accepted: 10/09/2022] [Indexed: 11/06/2022] Open
Abstract
An 86-year-old man who had undergone two mitral valve replacements developed heart failure due to prosthetic valve infection and left ventricular pseudoaneurysm (LVPA). LVPA due to infective endocarditis is rare and caused by the abscess formation in the left ventricular myocardium. Infective endocarditis caused by enterococci requires attention to relapse.
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Affiliation(s)
- Hironobu Nishiori
- Department of Cardiovascular SurgeryChiba University HospitalChibaJapan
| | - Goro Matsumiya
- Department of Cardiovascular SurgeryChiba University HospitalChibaJapan
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43
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Iosifescu AG, Iosifescu TA, Timisescu AT, Antohi EL, Iliescu VA. Left Ventricular Pseudoaneurysms Discovered Early After Acute Myocardial Infarction: The Surgical Timing Dilemma. Tex Heart Inst J 2022; 49:e207462. [PMID: 36194723 PMCID: PMC9632371 DOI: 10.14503/thij-20-7462] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
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.
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Affiliation(s)
- Andrei George Iosifescu
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
, Department of Cardiac Surgery, The Emergency Institute for Cardiovascular Diseases “Prof Dr C.C. Iliescu,” Bucharest, Romania
| | | | - Alina Teodora Timisescu
- Department of Cardiac Surgery, The Emergency Institute for Cardiovascular Diseases “Prof Dr C.C. Iliescu,” Bucharest, Romania
| | - Elena-Laura Antohi
- Department of Cardiology, The Emergency Institute for Cardiovascular Diseases “Prof Dr C.C. Iliescu,” Bucharest, Romania
| | - Vlad Anton Iliescu
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
, Department of Cardiac Surgery, The Emergency Institute for Cardiovascular Diseases “Prof Dr C.C. Iliescu,” Bucharest, Romania
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44
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TOSUN V. COVID-19 pnömonisi öntanısı alan ağır solunum yetmezliği ile sonuçlanan sağ atriyal psödoanevrizma olgusu. CUKUROVA MEDICAL JOURNAL 2022. [DOI: 10.17826/cumj.1121021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Kovid-19 pnömonisinden şüphelenilen ve ilk olarak akciğer bilgisayarlı tomografisinde pnömoni lezyonları tespit edilen bir hasta kardiyomegali nedeniyle transtorasik ekokardiyografi ile ayrıca değerlendirildi. Transtorasik ekokardiyografide sağ atriyumla ilişkili büyük bir rüptüre psödoanevrizma saptandı. Kontrastlı bilgisayarlı tomografide sağ atriyal psödoanevrizmada iki taraflı çok sayıda akciğer nodülü ve mural trombüs ile ilişkili pulmoner emboli görüldü.
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45
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Shuai X, Hu X, Wei Y. Case report: Spontaneous closure of ventricular pseudoaneurysm post-acute myocardial infarction with non-surgical therapy. Front Cardiovasc Med 2022; 9:996072. [PMID: 36204582 PMCID: PMC9530630 DOI: 10.3389/fcvm.2022.996072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2022] [Accepted: 08/26/2022] [Indexed: 11/13/2022] Open
Abstract
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.
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46
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Meshram R, Vaibhav V, Agrawal S, Khorwal G, Sharma K. Myocardial Infarction With Ventricular Wall Aneurysm: A Case Report. Cureus 2022; 14:e29017. [PMID: 36237811 PMCID: PMC9551642 DOI: 10.7759/cureus.29017] [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] [Accepted: 09/10/2022] [Indexed: 11/05/2022] Open
Abstract
A ventricular aneurysm can be pseudo or true; it is a rare complication of myocardial infarction induced by an intra-myocardial dissecting hematoma due to fragile myocardium. Ventricular wall rupture takes place two to four days after myocardial infarction when coagulative necrosis and inflammatory infiltrate and lysis of myocardial connective tissue results in weakening of infarcted myocardium. Acute cardiac wall ruptures are mostly fatal; an unwittingly located pericardial adhesion can abort a rupture resulting in a false aneurysm. The wall of a false aneurysm consists of the epicardium in contrast to a true aneurysm, which is composed of the myocardium. True aneurysms are complications seen in transmural infarcts. Thinned-out scar tissue paradoxically bulged during systole, and toughened fibrotic wall rupture doesn't usually occur. Deaths in subjects with true ventricular aneurysms occur due to mural thrombus, arrhythmias, and heart failure. We encountered a case of a true aneurysm, as reported below.
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47
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Naser JA, Anavekar NS. Left Ventricular Pseudoaneurysm: A Rare Cause of Chest Pain to Keep in Mind. Mayo Clin Proc 2022; 97:1523-1524. [PMID: 35933137 DOI: 10.1016/j.mayocp.2022.05.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Revised: 04/27/2022] [Accepted: 05/05/2022] [Indexed: 10/16/2022]
Affiliation(s)
- Jwan A Naser
- Department of Cardiovascular Medicine, Mayo Clinic College of Medicine, Rochester, MN.
| | - Nandan S Anavekar
- Department of Cardiovascular Medicine, Mayo Clinic College of Medicine, Rochester, MN
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48
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Kim M, Park YJ, Yu HT, Kim TH, Uhm JS, Joung B, Pak HN, Lee MH. Case Report: Delayed Ventricular Pseudoaneurysm After Radiofrequency Ablation of Left Posteromedial Papillary Muscle Ventricular Tachycardia. Front Cardiovasc Med 2022; 9:887190. [PMID: 35783824 PMCID: PMC9240706 DOI: 10.3389/fcvm.2022.887190] [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: 03/01/2022] [Accepted: 05/30/2022] [Indexed: 12/03/2022] Open
Abstract
A 74-year-old woman presented with incessant wide complex tachycardia that was refractory to cardioversions. Successful radiofrequency catheter ablation was performed on the left ventricular posteromedial papillary muscle. An inaudible steam pop has occurred during the procedure, but we confirmed that there were no complications during the procedure and short-term follow-up of echocardiography. Two months after the procedure, an asymptomatic pseudoaneurysm was identified at the ablation site that had not been observed in the short-term follow-up.
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Affiliation(s)
- Min Kim
- Division of Cardiology, Chungbuk National University Hospital, Cheongju, South Korea
| | - Yoon Jung Park
- Division of Cardiology, Yonsei University Health System, Seoul, South Korea
| | - Hee Tae Yu
- Division of Cardiology, Yonsei University Health System, Seoul, South Korea
| | - Tae-Hoon Kim
- Division of Cardiology, Yonsei University Health System, Seoul, South Korea
| | - Jae-Sun Uhm
- Division of Cardiology, Yonsei University Health System, Seoul, South Korea
| | - Boyoung Joung
- Division of Cardiology, Yonsei University Health System, Seoul, South Korea
| | - Hui-Nam Pak
- Division of Cardiology, Yonsei University Health System, Seoul, South Korea
| | - Moon-Hyoung Lee
- Division of Cardiology, Yonsei University Health System, Seoul, South Korea
- *Correspondence: Moon-Hyoung Lee,
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49
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Tien L, Drevets P, Ward A, Lee R. Left ventricular pseudoaneurysm repair utilizing P2 segment of mitral valve: a case report. THE CARDIOTHORACIC SURGEON 2022. [DOI: 10.1186/s43057-022-00073-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
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.
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50
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Torchio F, Garatti A, Ronco D, Matteucci M, Massimi G, Lorusso R. Left ventricular pseudoaneurysm: the niche of post-infarction mechanical complications. Ann Cardiothorac Surg 2022; 11:290-298. [PMID: 35733717 PMCID: PMC9207692 DOI: 10.21037/acs-2022-ami-25] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Accepted: 03/22/2022] [Indexed: 09/02/2024]
Abstract
Left ventricular pseudoaneurysm (LVP) is a very rare, but potentially lethal mechanical complication of acute myocardial infarction (AMI). Despite representing a unique subset of cardiac rupture, it presents peculiar features that distinguish it from both ventricular free-wall rupture (FWR) and ventricular true aneurysm. LVP occurs in less than 0.5% of patients affected by AMI. However, LVP is generally burdened by high mortality, often related to false cavity rupture, leading to catastrophic and often irreversible consequences. The risk of rupture is inversely proportional to the timing from AMI onset, which also determines both the classification of LVP and drives the indication for treatment. Despite the lack of a current consensus on LVP management, urgent surgery is the treatment of choice for LVPs occurring within 3 months from AMI, especially if larger than 3 cm in diameter. A matter of debate, however, is represented by chronic LVPs, especially because the risk of rupture decreases progressively as time passes and left ventricular (LV) false cavity stabilizes. Surgical mortality rate remains not negligible (more than 20%), but these suboptimal results may be considered acceptable, especially considering the lethality associated with the occurrence of pseudoaneurysm rupture. Diagnostic workup is essential for anatomical characterization of LV rupture, which is mandatory to guide the decision on surgical approach and technique for pseudoaneurysm repair. Finally, for a subset of patients with anterior LVP and a well-defined fibrotic neck, and deemed at excessively high surgical risk, percutaneous closure of the cavity has been described with encouraging results.
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Affiliation(s)
- Federica Torchio
- Department of Cardiothoracic Surgery, Heart and Vascular Centre, Maastricht University Medical Centre, Maastricht, The Netherlands
- Department of Medicine and Surgery, Circolo Hospital, University of Insubria, Varese, Italy
| | - Andrea Garatti
- Cardiac Surgery Unit, IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - Daniele Ronco
- Department of Cardiothoracic Surgery, Heart and Vascular Centre, Maastricht University Medical Centre, Maastricht, The Netherlands
- Department of Medicine and Surgery, Circolo Hospital, University of Insubria, Varese, Italy
| | - Matteo Matteucci
- Department of Cardiothoracic Surgery, Heart and Vascular Centre, Maastricht University Medical Centre, Maastricht, The Netherlands
- Department of Medicine and Surgery, Circolo Hospital, University of Insubria, Varese, Italy
| | - Giulio Massimi
- Department of Cardiothoracic Surgery, Heart and Vascular Centre, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Roberto Lorusso
- Department of Cardiothoracic Surgery, Heart and Vascular Centre, Maastricht University Medical Centre, Maastricht, The Netherlands
- Cardiovascular Research Institute Maastricht, Maastricht, The Netherlands
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