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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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Liu Y, Xu G, Shi F, Yang J, Gou R, Chen Z, Cao L. Case Report: A left ventricular pseudoaneurysm detected by cardiac magnetic resonance more than 1 year after a percutaneous transluminal coronary intervention. Front Cardiovasc Med 2024; 11:1348750. [PMID: 38576419 PMCID: PMC10991743 DOI: 10.3389/fcvm.2024.1348750] [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: 12/03/2023] [Accepted: 02/29/2024] [Indexed: 04/06/2024] Open
Abstract
Pseudoaneurysm is a rare but lethal complication of acute myocardial infarction. In this study, we present a unique case of a patient with left ventricular free wall rupture detected by cardiac magnetic resonance more than 1 year after a percutaneous transluminal coronary intervention.
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Affiliation(s)
- Yuanyuan Liu
- Department of Radiology, The First Hospital of Lanzhou University, Lanzhou, Gansu, China
- The First Clinical Medical College, Lanzhou University, Lanzhou, Gansu, China
| | - Ge Xu
- Department of Radiology, The First Hospital of Lanzhou University, Lanzhou, Gansu, China
- The First Clinical Medical College, Lanzhou University, Lanzhou, Gansu, China
| | - Funan Shi
- Department of Radiology, The First Hospital of Lanzhou University, Lanzhou, Gansu, China
- Lanzhou University Second Hospital, Lanzhou University, Lanzhou, Gansu, China
| | - Jing Yang
- Department of Radiology, The First Hospital of Lanzhou University, Lanzhou, Gansu, China
- Lanzhou University Second Hospital, Lanzhou University, Lanzhou, Gansu, China
| | - Ruiqiang Gou
- Department of Radiology, The First Hospital of Lanzhou University, Lanzhou, Gansu, China
- The First Clinical Medical College, Lanzhou University, Lanzhou, Gansu, China
| | - Zixian Chen
- Department of Radiology, The First Hospital of Lanzhou University, Lanzhou, Gansu, China
- Intelligent Imaging Medical Engineering Research Center of Gansu Province, Lanzhou, Gansu, China
- Accurate Image Collaborative Innovation International Science and Technology Cooperation Base of Gansu Province, Lanzhou, Gansu, China
- Radiological Clinical Medicine Research Center of Gansu Province, Lanzhou, Gansu, China
| | - Liang Cao
- Department of Radiology, The First Hospital of Lanzhou University, Lanzhou, Gansu, China
- Intelligent Imaging Medical Engineering Research Center of Gansu Province, Lanzhou, Gansu, China
- Accurate Image Collaborative Innovation International Science and Technology Cooperation Base of Gansu Province, Lanzhou, Gansu, China
- Radiological Clinical Medicine Research Center of Gansu Province, Lanzhou, Gansu, China
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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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A Pseudoaneurysm of Aberrant Right Subclavian Artery Caused by Esophageal Stent Placement Because of Esophageal Stricture After Endoscopic Submucosal Dissection. Surg Laparosc Endosc Percutan Tech 2020; 29:e69-e71. [PMID: 31246751 DOI: 10.1097/sle.0000000000000696] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
A 67-year-old man who received endoscopic submucosal dissection for an early squamous esophageal cancer was hospitalized for dysphagia. The mucosal defect was over three quarters of the circumference, and the distal edge of the resection scar formed the stenosis after 8 months. After experiencing conservative treatment, probe expansion, and esophageal stent placement, the symptom of deglutition disorder in the patient was improved, but persistent hemorrhage and progressive anemia occurred in the short term. An enhanced neck and chest computed tomography (CT) showed a contrast agent leaked from the aberrant right subclavian artery to the esophagus. A pseudoaneurysm of the aberrant right subclavian artery and subclavian artery-esophageal fistula were diagnosed by CT angiography. Although false aneurysms developing after iatrogenic injury and trauma have been reported, those caused by esophageal stent placement because of esophageal stricture after endoscopic submucosal dissection have not. When persistent hemorrhage and progressive anemia develop after esophageal stent placement, an enhanced CT should be performed to exclude the false aneurysm.
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Matteucci M, Fina D, Jiritano F, Meani P, Blankesteijn WM, Raffa GM, Kowaleski M, Heuts S, Beghi C, Maessen J, Lorusso R. Treatment strategies for post-infarction left ventricular free-wall rupture. EUROPEAN HEART JOURNAL-ACUTE CARDIOVASCULAR CARE 2019; 8:379-387. [PMID: 30932689 PMCID: PMC6572585 DOI: 10.1177/2048872619840876] [Citation(s) in RCA: 48] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Left ventricular free-wall rupture is one of the most fatal complications after
acute myocardial infarction. Surgical treatment of post-infarction left
ventricular free-wall rupture has evolved over time. Direct closure of the
ventricular wall defect (linear closure) and resection of the infarcted
myocardium (infarctectomy), with subsequent closure of the created defect with a
prosthetic patch, represented the original techniques. Recently, less aggressive
approaches, either with the use of surgical glues or the application of collagen
sponge patches on the infarct area to cover the tear and achieve haemostasis,
have been proposed. Despite such modifications in the therapeutic strategy and
surgical treatment, however, postoperative in-hospital mortality may be as high
as 35%. In extremely high-risk or inoperable patients, a non-surgical approach
has been reported.
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Affiliation(s)
- Matteo Matteucci
- 1 Department of Cardiothoracic Surgery, Heart and Vascular Centre, Maastricht University Medical Centre, The Netherlands.,2 Department of Cardiac Surgery, Circolo Hospital, University of Insubria, Varese, Italy
| | - Dario Fina
- 3 Department of Cardiology, IRCCS Policlinico San Donato, University of Milan, Italy.,4 Department of Cardiology, Heart and Vascular Centre, Maastricht University Medical Centre, The Netherlands
| | - Federica Jiritano
- 1 Department of Cardiothoracic Surgery, Heart and Vascular Centre, Maastricht University Medical Centre, The Netherlands.,5 Department of Cardiac Surgery, University Magna Graecia of Catanzaro, Italy
| | - Paolo Meani
- 1 Department of Cardiothoracic Surgery, Heart and Vascular Centre, Maastricht University Medical Centre, The Netherlands.,4 Department of Cardiology, Heart and Vascular Centre, Maastricht University Medical Centre, The Netherlands
| | - W Matthijs Blankesteijn
- 6 Department of Pharmacology and Toxicology, Cardiovascular Research Institute Maastricht, Maastricht University, The Netherlands
| | - Giuseppe Maria Raffa
- 7 Department for the Treatment and Study of Cardiothoracic Diseases and Cardiothoracic Transplantation, IRCCS-ISMETT, Palermo, Italy
| | - Mariusz Kowaleski
- 8 Clinical Department of Cardiac Surgery, Central Clinical Hospital of the Ministry of Interior in Warsaw, Poland
| | - Samuel Heuts
- 1 Department of Cardiothoracic Surgery, Heart and Vascular Centre, Maastricht University Medical Centre, The Netherlands
| | - Cesare Beghi
- 2 Department of Cardiac Surgery, Circolo Hospital, University of Insubria, Varese, Italy
| | - Jos Maessen
- 1 Department of Cardiothoracic Surgery, Heart and Vascular Centre, Maastricht University Medical Centre, The Netherlands.,9 Cardiovascular Research Institute Maastricht, Maastricht University, The Netherlands
| | - Roberto Lorusso
- 1 Department of Cardiothoracic Surgery, Heart and Vascular Centre, Maastricht University Medical Centre, The Netherlands.,9 Cardiovascular Research Institute Maastricht, Maastricht University, The Netherlands
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Inayat F, Ghani AR, Riaz I, Ali NS, Sarwar U, Bonita R, Virk HUH. Left Ventricular Pseudoaneurysm: An Overview of Diagnosis and Management. J Investig Med High Impact Case Rep 2018; 6:2324709618792025. [PMID: 30090827 PMCID: PMC6077878 DOI: 10.1177/2324709618792025] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Accepted: 06/23/2018] [Indexed: 11/16/2022] Open
Abstract
Left ventricular pseudoaneurysm is a rare but life-threatening disorder that is frequently reported secondary to myocardial infarction or cardiac surgery. In this article, we chronicle the case of a patient with no prior risk factors who presented with a 2-week history of nonexertional atypical left chest pain. Apical 2-chamber transthoracic echocardiography revealed an unexpected outpouching of basal inferoseptal wall of the left ventricle, which had a narrow neck and relatively wide apex. The patient was diagnosed with left ventricular pseudoaneurysm and medical therapy was initiated. He refused to undergo the surgical intervention and subsequently, he was discharged from the hospital in stable condition. This article illustrates that physicians should be vigilant for atypical presentations of left ventricular pseudoaneurysm, and a high index of suspicion should be maintained for this stealth killer while performing appropriate diagnostic imaging. Additionally, we review the currently available approaches to diagnosis and management in these patients.
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Affiliation(s)
| | | | - Iqra Riaz
- Einstein Medical Center, Philadelphia, PA, USA
| | | | - Usman Sarwar
- Abington Hospital-Jefferson Health, Abington, PA, USA
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