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Fukui T, Kitabayashi K, Ogasawara N, Hasegawa S. Subepicardial aneurysm with free wall rupture and its successful surgical intervention: a case report. EUROPEAN HEART JOURNAL-CASE REPORTS 2021; 5:ytab048. [PMID: 33738421 PMCID: PMC7954271 DOI: 10.1093/ehjcr/ytab048] [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] [Received: 11/19/2020] [Revised: 12/09/2020] [Accepted: 01/20/2021] [Indexed: 12/02/2022]
Abstract
Background Subepicardial aneurysm (SEA) is an uncommon but potentially fatal complication of acute myocardial infarction (MI) associated with an increased risk of free wall rupture (FWR) leading to sudden death. We describe a rare case of a silent myocardial infarction complicated by SEA and subsequent FWR, resulting in cardiac tamponade. Case summary A 68-year-old man with no previous chest symptoms presented with syncope. Cardiac computed tomography incidentally revealed a small aneurysmal cavity at the inferolateral wall of the left ventricle, which was overlooked on initial transthoracic echocardiography. Coronary angiography demonstrated a narrowed first obtuse marginal branch with coronary slow flow, suggesting that spontaneous recanalization of the occluded obtuse marginal branch induced SEA and subsequent FWR. The patient underwent an emergency left ventricular aneurysm repair. The post-operative course was uneventful, and the patient was discharged from the hospital on post-operative day 20. Discussion This case emphasizes the importance of prompt detection and surgical intervention for SEA. Subepicardial aneurysm should be suspected in patients with pericardial effusion and suspected MI. Cardiac computed tomography is not only useful in the detection of such cases but also facilitates the development of a successful surgical strategy.
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Affiliation(s)
- Tomoki Fukui
- Department of Cardiology, Japan Community Healthcare Organization Osaka Hospital, 4-2-78, Fukushima, Fukushima-Ku, Osaka city, Osaka, 553-0003, Japan
| | - Katsukiyo Kitabayashi
- Department of Cardiovascular Surgery, Japan Community Healthcare Organization Osaka Hospital, 4-2-78, Fukushima, Fukushima-Ku, Osaka city, Osaka 553-0003, Japan
| | - Nobuyuki Ogasawara
- Department of Cardiology, Japan Community Healthcare Organization Osaka Hospital, 4-2-78, Fukushima, Fukushima-Ku, Osaka city, Osaka, 553-0003, Japan
| | - Shinji Hasegawa
- Department of Cardiology, Japan Community Healthcare Organization Osaka Hospital, 4-2-78, Fukushima, Fukushima-Ku, Osaka city, Osaka, 553-0003, Japan
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Zheng Y, Sun JP, Shen X, Qiao Z, Ge H, Li Z, He B, Yu CM. Subepicardial Aneurysm That Was Diagnosed by Cardiac Imaging and Underwent Successful Surgery. Circulation 2016; 132:e149-51. [PMID: 26391298 DOI: 10.1161/circulationaha.115.018427] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Ying Zheng
- From Department of Cardiology, Renji Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China (Y.Z., X.S., Z.Q., H.G., Z.L., B.H.); and Division of Cardiology, Prince of Wales Hospital, Chinese University of Hong Kong, Shatin, Hong Kong (J.P.S., C.-M.Y.)
| | - Jing Ping Sun
- From Department of Cardiology, Renji Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China (Y.Z., X.S., Z.Q., H.G., Z.L., B.H.); and Division of Cardiology, Prince of Wales Hospital, Chinese University of Hong Kong, Shatin, Hong Kong (J.P.S., C.-M.Y.)
| | - Xuedong Shen
- From Department of Cardiology, Renji Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China (Y.Z., X.S., Z.Q., H.G., Z.L., B.H.); and Division of Cardiology, Prince of Wales Hospital, Chinese University of Hong Kong, Shatin, Hong Kong (J.P.S., C.-M.Y.)
| | - Zhiqing Qiao
- From Department of Cardiology, Renji Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China (Y.Z., X.S., Z.Q., H.G., Z.L., B.H.); and Division of Cardiology, Prince of Wales Hospital, Chinese University of Hong Kong, Shatin, Hong Kong (J.P.S., C.-M.Y.)
| | - Heng Ge
- From Department of Cardiology, Renji Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China (Y.Z., X.S., Z.Q., H.G., Z.L., B.H.); and Division of Cardiology, Prince of Wales Hospital, Chinese University of Hong Kong, Shatin, Hong Kong (J.P.S., C.-M.Y.)
| | - Zheng Li
- From Department of Cardiology, Renji Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China (Y.Z., X.S., Z.Q., H.G., Z.L., B.H.); and Division of Cardiology, Prince of Wales Hospital, Chinese University of Hong Kong, Shatin, Hong Kong (J.P.S., C.-M.Y.)
| | - Ben He
- From Department of Cardiology, Renji Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China (Y.Z., X.S., Z.Q., H.G., Z.L., B.H.); and Division of Cardiology, Prince of Wales Hospital, Chinese University of Hong Kong, Shatin, Hong Kong (J.P.S., C.-M.Y.)
| | - Cheuk-Man Yu
- From Department of Cardiology, Renji Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China (Y.Z., X.S., Z.Q., H.G., Z.L., B.H.); and Division of Cardiology, Prince of Wales Hospital, Chinese University of Hong Kong, Shatin, Hong Kong (J.P.S., C.-M.Y.).
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