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Bhushan R, Ramesh AK, Grover V. Delayed traumatic left ventricular pseudoaneurysm: diagnostic challenges and surgical management. Indian J Thorac Cardiovasc Surg 2024; 40:621-625. [PMID: 39156074 PMCID: PMC11329469 DOI: 10.1007/s12055-024-01729-2] [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: 01/15/2024] [Revised: 03/19/2024] [Accepted: 03/19/2024] [Indexed: 08/20/2024] Open
Abstract
Left ventricular (LV) pseudoaneurysms are uncommon, with traumatic cases being particularly rare. We present a case of a 26-year-old male with a delayed presentation of a traumatic LV pseudoaneurysm, 2 years post-blunt chest trauma. The patient experienced New York Heart Association (NYHA) grade 2 dyspnea, which prompted the investigation. Imaging studies, including X-ray, echocardiogram, and cardiac computed tomography (CT), revealed a large pseudoaneurysm arising from the LV apex, containing intramural thrombus. The surgical intervention involved the closure of the communicating orifice and on-lay pericardial patch placement. This case emphasizes the diagnostic challenges and successful management of traumatic LV pseudoaneurysms. Early detection through imaging and prompt surgical intervention led to a favorable outcome. This report contributes to understanding post-traumatic pseudoaneurysms and underscores the importance of a multidisciplinary approach in their management. Further studies are needed to refine diagnostic and treatment strategies for this rare condition.
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Affiliation(s)
- Rahul Bhushan
- Department of CTVS, ABVIMS and Dr RML Hospital, New Delhi, 110001 India
| | | | - Vijay Grover
- Department of CTVS, ABVIMS and Dr RML Hospital, New Delhi, 110001 India
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2
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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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3
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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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4
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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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5
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Elkattawy S, Romero J, Romero AL, Elkattawy O, Patel R, Shamoon R, Shamoon F. Contained Left Ventricular Free Wall Rupture Following a Silent Myocardial Infarction. J Community Hosp Intern Med Perspect 2023; 13:5-7. [PMID: 38596559 PMCID: PMC11000830 DOI: 10.55729/2000-9666.1240] [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: 03/29/2023] [Revised: 06/08/2023] [Accepted: 06/27/2023] [Indexed: 04/11/2024] Open
Abstract
A left ventricular pseudoaneurysm (LVP) is defined as an outpouching contained by the surrounding pericardium. Clinical presentation is often unspecific with patients presenting with chest pain, dyspnea, symptoms consistent with heart failure, and post-myocardial infarction. Cardiac magnetic resonance imaging represents an important tool for differentiating a pseudoaneurysm from a true aneurysm. Furthermore, multiple imagining modalities are available, including transesophageal and transthoracic echocardiogram and contrast ventriculography, which remains the gold standard diagnostic technique. Early recognition and prompt surgical management are of utmost importance in patients with acute and symptomatic LVP. On the other hand, medical management may be considered in patients with chronic and small pseudoaneurysms. Here, we are presenting a 74-year-old lady who presented with chest pain and was found to have a chronic and small LVP which was managed conservatively.
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Affiliation(s)
- Sherif Elkattawy
- Cardiology Department, St. Joseph’s University Medical Center, Paterson, NJ,
USA
| | - Jesus Romero
- Internal Medicine Department, RWJBarnabas Health/Trinitas Regional Medical Center, Elizabeth, NJ,
USA
| | - Ana L. Romero
- Internal Medicine Department, RWJBarnabas Health/Trinitas Regional Medical Center, Elizabeth, NJ,
USA
| | - Omar Elkattawy
- Internal Medicine Department, Rutgers University-New Brunswick, Jersey City, NJ,
USA
| | - Roma Patel
- Internal Medicine Department, RWJBarnabas Health/Trinitas Regional Medical Center, Elizabeth, NJ,
USA
| | - Razan Shamoon
- Cardiology Department, St. Joseph’s University Medical Center, Paterson, NJ,
USA
| | - Fayez Shamoon
- Cardiology Department, St. Joseph’s University Medical Center, Paterson, NJ,
USA
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6
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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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7
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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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8
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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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9
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Meuleman L, Vanderheeren P, Bresseleers J, Desimpel F, Van Petegem S, Defruyt L. Left ventricular pseudoaneurysm: another brick in the wall. Acta Cardiol 2022; 77:754-755. [PMID: 34404332 DOI: 10.1080/00015385.2021.1963103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Affiliation(s)
- Lore Meuleman
- Department of Public Health and Primary Care, Gent University, Corneel, Gent, Belgium
| | | | - Jan Bresseleers
- Cardiology Department, Sint-Andriesziekenhuis Tielt, Tielt, Belgium
| | | | | | - Loran Defruyt
- Cardiology Department, Sint-Andriesziekenhuis Tielt, Tielt, Belgium
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10
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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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11
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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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12
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Sadeghi R, Tomka B, Khodaei S, Daeian M, Gandhi K, Garcia J, Keshavarz-Motamed Z. Impact of extra-anatomical bypass on coarctation fluid dynamics using patient-specific lumped parameter and Lattice Boltzmann modeling. Sci Rep 2022; 12:9718. [PMID: 35690596 PMCID: PMC9188592 DOI: 10.1038/s41598-022-12894-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Accepted: 04/11/2022] [Indexed: 01/28/2023] Open
Abstract
Accurate hemodynamic analysis is not only crucial for successful diagnosis of coarctation of the aorta (COA), but intervention decisions also rely on the hemodynamics assessment in both pre and post intervention states to minimize patient risks. Despite ongoing advances in surgical techniques for COA treatments, the impacts of extra-anatomic bypass grafting, a surgical technique to treat COA, on the aorta are not always benign. Our objective was to investigate the impact of bypass grafting on aortic hemodynamics. We investigated the impact of bypass grafting on aortic hemodynamics using a patient-specific computational-mechanics framework in three patients with COA who underwent bypass grafting. Our results describe that bypass grafting improved some hemodynamic metrics while worsened the others: (1) Doppler pressure gradient improved (decreased) in all patients; (2) Bypass graft did not reduce the flow rate substantially through the COA; (3) Systemic arterial compliance increased in patients #1 and 3 and didn't change (improve) in patient 3; (4) Hypertension got worse in all patients; (5) The flow velocity magnitude improved (reduced) in patient 2 and 3 but did not improve significantly in patient 1; (6) There were elevated velocity magnitude, persistence of vortical flow structure, elevated turbulence characteristics, and elevated wall shear stress at the bypass graft junctions in all patients. We concluded that bypass graft may lead to pseudoaneurysm formation and potential aortic rupture as well as intimal hyperplasia due to the persistent abnormal and irregular aortic hemodynamics in some patients. Moreover, post-intervention, exposures of endothelial cells to high shear stress may lead to arterial remodeling, aneurysm, and rupture.
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Affiliation(s)
- Reza Sadeghi
- grid.25073.330000 0004 1936 8227Department of Mechanical Engineering, McMaster University, Hamilton, Canada ON
| | - Benjamin Tomka
- grid.25073.330000 0004 1936 8227Department of Mechanical Engineering, McMaster University, Hamilton, Canada ON
| | - Seyedvahid Khodaei
- grid.25073.330000 0004 1936 8227Department of Mechanical Engineering, McMaster University, Hamilton, Canada ON
| | - MohammadAli Daeian
- grid.25073.330000 0004 1936 8227Department of Mechanical Engineering, McMaster University, Hamilton, Canada ON
| | - Krishna Gandhi
- grid.25073.330000 0004 1936 8227Department of Mechanical Engineering, McMaster University, Hamilton, Canada ON
| | - Julio Garcia
- grid.489011.50000 0004 0407 3514Stephenson Cardiac Imaging Centre, Libin Cardiovascular Institute of Alberta, Calgary, AB Canada ,grid.22072.350000 0004 1936 7697Department of Radiology, University of Calgary, Calgary, AB Canada ,grid.22072.350000 0004 1936 7697Department of Cardiac Sciences, University of Calgary, Calgary, AB Canada ,grid.413571.50000 0001 0684 7358Alberta Children’s Hospital Research Institute, Calgary, AB Canada
| | - Zahra Keshavarz-Motamed
- grid.25073.330000 0004 1936 8227Department of Mechanical Engineering, McMaster University, Hamilton, Canada ON ,grid.25073.330000 0004 1936 8227School of Biomedical Engineering, McMaster University, Hamilton, ON Canada ,grid.25073.330000 0004 1936 8227School of Computational Science and Engineering, McMaster University, Hamilton, ON Canada
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13
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Denman E, Marvaki A, Huang M, Lamas S, Harrison J, Ammar T, Deshpande R, Monaghan MJ, Papachristidis A. Unexpected finding after aortic arch operation: a left ventricular pseudoaneurysm - Who is the culprit? Echocardiography 2022; 39:732-734. [PMID: 35342973 DOI: 10.1111/echo.15341] [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: 09/27/2021] [Revised: 01/24/2022] [Accepted: 02/27/2022] [Indexed: 11/30/2022] Open
Abstract
We present a case of a 61-year-old female who, after undergoing frozen elephant trunk surgery, was found to have an unexpected left ventricular pseudoaneurysm on transthoracic echocardiogram. The pseudoaneurysm was caused by the left ventricular vent catheter constantly impinging the LV wall of the beating heart during surgery. Contrast echocardiography, cardiac magnetic resonance imaging and computed tomography (CT) imaging confirmed the diagnosis and served for follow-up demonstrating the narrow neck and outpouching structure on the apical lateral wall. The patient remains asymptomatic two years after the operation and is being followed up with echocardiography and CT imaging.
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Affiliation(s)
- Emily Denman
- Denmark Hill, King's College Hospital, London, UK
| | | | | | - Sergio Lamas
- Denmark Hill, King's College Hospital, London, UK
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14
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Al Lawati A, Al-Hadhrami W, Al Hosni F, Al Lawati M, Elseragy E, Sirasanagandla S, Al Lawati A, Al-Attraqchi M, AL Umairi RS. A Rare Case of a Left Ventricular Pseudoaneurysm With Lateral Wall Rupture. Cureus 2022; 14:e22909. [PMID: 35399471 PMCID: PMC8985382 DOI: 10.7759/cureus.22909] [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: 03/07/2022] [Indexed: 11/17/2022] Open
Abstract
In this report, we present a case of a 51-year-old male patient with a left ventricular (LV) pseudoaneurysm and a ruptured lateral wall due to a previous myocardial infarction. This patient was referred to the Coronary Care Unit with a past history of acute coronary syndrome of two months. He presented with palpitations and acute pulmonary edema upon admission. Color Doppler detected a ruptured lateral ventricular wall, and an echocardiogram confirmed the presence of a lateral ventricular wall pseudoaneurysm. Emergency LV aneurysmal rupture repair surgery was performed on this patient, and the postoperative findings were stable till discharge.
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15
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Alsomali A, Eltayeb A, Aldosari S, AlShahid M, AlSanei A, AlEnazy A, Vriz O. Recurrence of left ventricular pseudoaneurysm after multiple mitral valve replacements. Monaldi Arch Chest Dis 2021; 92. [PMID: 34634901 DOI: 10.4081/monaldi.2021.2043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Accepted: 08/22/2021] [Indexed: 11/23/2022] Open
Abstract
Left ventricular pseudoaneurysm (LVPA) formation is a potentially lethal complication of myocardial infarction (MI] and mitral valve (MV) replacement that requires prompt diagnosis and treatment. A female patient who had been complaining of exertional dyspnea underwent a two-dimensional transthoracic echocardiogram (TTE) which revealed a functioning mechanical MV with severe paravalvular leak, severe tricuspid regurgitation (TR) and severely elevated pulmonary artery systolic pressure. Moreover, echo-lucent space at the postero-lateral portion of the left ventricle near the MV was seen, suggestive of a large LVPA. Transesophageal echocardiography (TEE) and Computed Tomography (CT) angiography confirmed these findings. Afterwards, the patient had a surgical repair for the LVPA along with mitral and tricuspid valve (TV) replacement. Three months later, the patient presented with symptoms of congestive heart failure. The LVPA had recurred at the same location of the previous pseudoaneurysm and given the high risk for reoperating on the patient, close monitoring and medical management was deemed as a better option.
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Affiliation(s)
| | | | | | - Maie AlShahid
- King Faisal Specialist Hospital and Research Centre, Riyadh.
| | - Aly AlSanei
- King Faisal Specialist Hospital and Research Centre, Riyadh.
| | - Ali AlEnazy
- King Faisal Specialist Hospital and Research Centre, Riyadh.
| | - Olga Vriz
- College of Medicine, Alfaisal University, Riyadh; King Faisal Specialist Hospital and Research Centre, Riyadh.
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16
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Cardiac Outpouchings: Definitions, Differential Diagnosis, and Therapeutic Approach. Cardiol Res Pract 2021; 2021:6792643. [PMID: 34567801 PMCID: PMC8463251 DOI: 10.1155/2021/6792643] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Accepted: 08/30/2021] [Indexed: 02/06/2023] Open
Abstract
Background and Aims Cardiac outpouchings encounter a series of distinct congenital or acquired entities (i.e. aneurysms, pseudoaneurysms, diverticula, and herniations), whose knowledge is still poorly widespread in clinical practice. This review aims to provide a comprehensive overview focusing on definition, differential diagnosis, and prognostic outcomes of cardiac outpouchings, as well as further insights on therapeutic options, in order to assist physicians in the most appropriate decision-making. Methods The material reviewed was obtained by the following search engines: MEDLINE (PubMed), EMBASE, Google Scholar, and Clinical Trials databases, from January 1966 until March 2021. We searched for the following keywords (in title and/or abstract): (“cardiac” OR “heart”) AND (“outpouching” OR “outpouch” OR “aneurysm” OR “pseudoaneurysm” OR “false aneurysm” OR “diverticulum” OR “herniation”). Review articles, original articles, case series, and case reports with literature review were included in our search. Data from patients with congenital or acquired cardiac outpouchings, from prenatal to geriatric age range, were investigated. Results Out of the 378 papers initially retrieved, 165 duplicates and 84 records in languages other than English were removed. Among the 129 remaining articles, 76 were included in our research material, on the basis of the following inclusion criteria: (a) papers pertaining to the research topic; (b) peer-reviewed articles; (c) using standardized diagnostic criteria; and (d) reporting raw prevalence data. Location, morphologic features, wall motion abnormalities, and tissue characterization were found to have a significant impact in recognition and differential diagnosis of cardiac outpouchings as well as to play a significant role in defining their natural history and prognostic outcomes. Conclusions Careful recognition of cardiac outpouchings remains a diagnostic challenge in clinical practice. Due to a broad cluster of distinctive and heterogeneous entities, their knowledge and timely recognition play a pivotal role in order to provide the most appropriate clinical management and therapeutic approach.
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17
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Celi S, Gasparotti E, Capellini K, Vignali E, Fanni BM, Ali LA, Cantinotti M, Murzi M, Berti S, Santoro G, Positano V. 3D Printing in Modern Cardiology. Curr Pharm Des 2021; 27:1918-1930. [PMID: 32568014 DOI: 10.2174/1381612826666200622132440] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Accepted: 05/05/2020] [Indexed: 11/22/2022]
Abstract
BACKGROUND 3D printing represents an emerging technology in the field of cardiovascular medicine. 3D printing can help to perform a better analysis of complex anatomies to optimize intervention planning. METHODS A systematic review was performed to illustrate the 3D printing technology and to describe the workflow to obtain 3D printed models from patient-specific images. Examples from our laboratory of the benefit of 3D printing in planning interventions were also reported. RESULTS 3D printing technique is reliable when applied to high-quality 3D image data (CTA, CMR, 3D echography), but it still needs the involvement of expert operators for image segmentation and mesh refinement. 3D printed models could be useful in interventional planning, although prospective studies with comprehensive and clinically meaningful endpoints are required to demonstrate the clinical utility. CONCLUSION 3D printing can be used to improve anatomy understanding and surgical planning.
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Affiliation(s)
- Simona Celi
- BioCardioLab, Fondazione Toscana "G. Monasterio", Massa, Italy
| | | | - Katia Capellini
- BioCardioLab, Fondazione Toscana "G. Monasterio", Massa, Italy
| | | | - Benigno M Fanni
- BioCardioLab, Fondazione Toscana "G. Monasterio", Massa, Italy
| | - Lamia A Ali
- Pediatric Cardiology Unit, Fondazione Toscana "G. Monasterio" Massa, Italy
| | | | - Michele Murzi
- Adult Cardiosurgery Unit, Fondazione Toscana "G. Monasterio", Massa, Italy
| | - Sergio Berti
- Adult Interventional Cardiology Unit, Fondazione Toscana "G. Monasterio", Massa, Italy
| | - Giuseppe Santoro
- Pediatric Cardiology Unit, Fondazione Toscana "G. Monasterio" Massa, Italy
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18
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Donuru A, Saul D, Parekh M, Kumaran M, Kandula V, Kharouf R. Gunshot-Related Pediatric Left Ventricular Apical Aneurysm. JACC Case Rep 2021; 3:26-30. [PMID: 34317463 PMCID: PMC8305065 DOI: 10.1016/j.jaccas.2020.10.013] [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: 07/21/2020] [Revised: 09/30/2020] [Accepted: 10/19/2020] [Indexed: 11/17/2022]
Abstract
Penetrating injuries of the thorax and abdomen, such as gunshot and stabbing, are rare in children. We present the case of a pediatric patient with a history of remote gunshot injury presenting with a late aneurysm in the left ventricle. (Level of Difficulty: Intermediate.).
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Affiliation(s)
- Achala Donuru
- Department of Radiology, Thomas Jefferson University Hospitals, Philadelphia, Pennsylvania, USA
- Address for correspondence: Dr. Achala Donuru, Department of Radiology, Thomas Jefferson University Hospitals, 132 S. 10th Street, 1079 Main Building, Philadelphia, Pennsylvania 19107, USA.
| | - David Saul
- Department of Medical Imaging, A.I. DuPont Hospital for Children, Wilmington, Delaware, USA
| | - Maansi Parekh
- Department of Radiology, Thomas Jefferson University Hospitals, Philadelphia, Pennsylvania, USA
| | - Maruti Kumaran
- Department of Radiology, Temple University, Philadelphia, Pennsylvania, USA
| | - Vinay Kandula
- Department of Medical Imaging, A.I. DuPont Hospital for Children, Wilmington, Delaware, USA
| | - Rami Kharouf
- Department of Cardiology, A.I. DuPont Hospital for Children, Wilmington, Delaware, USA
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19
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Banisauskaite A, Velavan P, Hasleton J, Mediratta N, Arzanauskaite M, Binukrishnan S. Myocardial rupture and left ventricular pseudoaneurysm due to late STEMI presentation during the COVID-19 pandemic lockdown: a classical case report. EUROPEAN HEART JOURNAL-CASE REPORTS 2021; 5:ytab253. [PMID: 34377907 PMCID: PMC8343434 DOI: 10.1093/ehjcr/ytab253] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/13/2020] [Revised: 03/02/2021] [Accepted: 06/10/2021] [Indexed: 02/07/2023]
Abstract
Background Left ventricular (LV) pseudoaneurysm is a serious and rare complication of myocardial infarction (MI). It occurs when an injured myocardial wall ruptures and is contained by overlying adherent pericardium or scar tissue, most commonly it develops in patients with late presentation of MI and delayed revascularization. Case summary A 64-year-old man presented to the emergency department with intermittent central chest pain radiating to back and neck and increasing on deep inspiration, which was considered to be of musculoskeletal origin for a week, but worsened despite medications. Electrocardiography showed features of ST-elevation MI; a circumflex artery occlusion was found on coronary angiogram and angioplasty was performed. Cardiovascular magnetic resonance (CMR) revealed features of healed lateral wall rupture with adherent parietal pericardium and the patient was managed conservatively. Two months later the patient returned with severe chest pain; echocardiogram and cardiac computed tomography showed significant interval progression of the pseudoaneurysm. Aneurysmectomy was performed, after which the patient recovered and had none of the previous symptoms since. Follow-up CMR study revealed improvement of LV systolic function. Discussion A rare case of post-infarction LV pseudoaneurysm was reported. Multimodality imaging helped to detect and to differentiate this complication from the true aneurysm and to follow it up and plan the treatment. Conservative treatment was not effective in this case as the pseudoaneurysm progressed; aneurysmectomy helped to improve LV systolic function.
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Affiliation(s)
- Audra Banisauskaite
- Radiology Department, Liverpool Heart and Chest Hospital NHS Foundation Trust, Thomas Drive, Liverpool L14 3PE, UK.,Radiology Department, Lithuanian University of Health Sciences, Eivenių str. 2, Kaunas 50161, Lithuania
| | - Periaswamy Velavan
- Cardiology Department, Liverpool Heart and Chest Hospital NHS Foundation Trust, Thomas Drive, Liverpool L14 3PE, UK
| | - Jonathan Hasleton
- Cardiology Department, Liverpool Heart and Chest Hospital NHS Foundation Trust, Thomas Drive, Liverpool L14 3PE, UK
| | - Neeraj Mediratta
- Cardiac Surgery Department, Liverpool Heart and Chest Hospital NHS Foundation Trust, Thomas Drive, Liverpool L14 3PE, UK
| | - Monika Arzanauskaite
- Radiology Department, Liverpool Heart and Chest Hospital NHS Foundation Trust, Thomas Drive, Liverpool L14 3PE, UK.,Cardiovascular Program ICCC - Research Institute Hospital de la Santa Creu i Sant Pau, IIB-Sant Pau, Carrer de Sant Quintí, 89, 08041 Barcelona, Spain
| | - Sukumaran Binukrishnan
- Radiology Department, Liverpool Heart and Chest Hospital NHS Foundation Trust, Thomas Drive, Liverpool L14 3PE, UK
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20
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Surgical Treatment of Chronic Giant Left Ventricular Pseudoaneurysm. Case Rep Cardiol 2021; 2021:4308690. [PMID: 33628516 PMCID: PMC7892212 DOI: 10.1155/2021/4308690] [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: 03/30/2020] [Revised: 12/20/2020] [Accepted: 01/31/2021] [Indexed: 11/29/2022] Open
Abstract
Left ventricle pseudoaneurysm is usually a severe complication of acute myocardial infarction, caused by rupture of the myocardial wall with pericardium bleeding. Mortality can reach 50 to 80% within a week if not properly treated. Hemodynamic instability, cardiac tamponade, and cardiac arrest are life-threatening presentations that require surgical treatment. We report a case of a man with a left ventricle chronic giant pseudoaneurysm and unspecific symptoms. After critical judgement on a heart team basis, surgical treatment was successfully performed, with a good long-term clinical outcome.
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21
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Goraya MHN, Kalsoom S, Almas T, Amin MK, Hussain N, Awan JR, Ehtesham M, Niaz MA, Virk HUH, Filby SJ. Simultaneous Left Ventricular Aneurysm and Ventricular Septal Rupture Complicating Delayed STEMI Presentation: A Case-Based Review of Post-MI Mechanical Complications Amid the COVID-19 Pandemic. J Investig Med High Impact Case Rep 2021; 9:23247096211031135. [PMID: 34259086 PMCID: PMC8283223 DOI: 10.1177/23247096211031135] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Revised: 06/15/2021] [Accepted: 06/18/2021] [Indexed: 11/23/2022] Open
Abstract
Amid the coronavirus disease 2019 (COVID-19) pandemic, there is an unprecedented increase in public avoidance of hospitals predominantly driven by fear of contracting the virus. Recent publications highlight a re-emergence of rare post-myocardial infarction complications. While mechanical complications are infrequent in the era of primary percutaneous coronary intervention, they are associated with high mortality rates. The concurrent occurrence of mechanical complications such as left ventricular aneurysm and ventricular septal rupture is an extremely rare entity. We hereby delineate a unique case of a 53-year-old Caucasian male who underwent successful concomitant closure of a ventricular septal rupture, left ventricular aneurysmectomy, and 3-vessel coronary artery bypass grafting. Due to a delayed initial presentation owing to the patient's fear of contracting COVID-19, the surgery was carried out 3 months after the myocardial infarction. His postoperative evaluation confirmed normal contractility of the left ventricle and complete closure of the ventricular septal rupture. Six months postoperatively, the patient continues to do well. We also present a literature review of the mechanical complications following delayed presentation of myocardial infarction amid the COVID-19 pandemic. This article illustrates that clinicians should remain cognizant of these extremely rare but potentially lethal collateral effects during the ongoing global public-health challenge. Furthermore, it highlights a significant concern regarding the delay in first medical contact due to the reluctance of patients to visit the hospital during the COVID-19 pandemic.
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Affiliation(s)
| | - Sidra Kalsoom
- Conemaugh Memorial Medical Center, Johnstown, PA, USA
| | - Talal Almas
- Royal College of Surgeons in Ireland, Dublin, Ireland
| | | | | | | | | | | | | | - Steven J. Filby
- University Hospitals Cleveland Medical Center, Cleveland, OH, USA
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22
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Steijns F, Renard M, Vanhomwegen M, Vermassen P, Desloovere J, Raedt R, Larsen LE, Tóth MI, De Backer J, Sips P. Spontaneous Right Ventricular Pseudoaneurysms and Increased Arrhythmogenicity in a Mouse Model of Marfan Syndrome. Int J Mol Sci 2020; 21:E7024. [PMID: 32987703 PMCID: PMC7582482 DOI: 10.3390/ijms21197024] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2020] [Revised: 09/22/2020] [Accepted: 09/22/2020] [Indexed: 02/08/2023] Open
Abstract
Patients with Marfan syndrome (MFS), a connective tissue disorder caused by pathogenic variants in the gene encoding the extracellular matrix protein fibrillin-1, have an increased prevalence of primary cardiomyopathy, arrhythmias, and sudden cardiac death. We have performed an in-depth in vivo and ex vivo study of the cardiac phenotype of Fbn1mgR/mgR mice, an established mouse model of MFS with a severely reduced expression of fibrillin-1. Using ultrasound measurements, we confirmed the presence of aortic dilatation and observed cardiac diastolic dysfunction in male Fbn1mgR/mgR mice. Upon post-mortem examination, we discovered that the mutant mice consistently presented myocardial lesions at the level of the right ventricular free wall, which we characterized as spontaneous pseudoaneurysms. Histological investigation demonstrated a decrease in myocardial compaction in the MFS mouse model. Furthermore, continuous 24 h electrocardiographic analysis showed a decreased heart rate variability and an increased prevalence of extrasystolic arrhythmic events in Fbn1mgR/mgR mice compared to wild-type littermates. Taken together, in this paper we document a previously unreported cardiac phenotype in the Fbn1mgR/mgR MFS mouse model and provide a detailed characterization of the cardiac dysfunction and rhythm disorders which are caused by fibrillin-1 deficiency. These findings highlight the wide spectrum of cardiac manifestations of MFS, which might have implications for patient care.
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Affiliation(s)
- Felke Steijns
- Center for Medical Genetics, Department of Biomolecular Medicine, Ghent University, 9000 Ghent, Belgium; (F.S.); (M.R.); (M.V.); (P.V.); (J.D.B.)
| | - Marjolijn Renard
- Center for Medical Genetics, Department of Biomolecular Medicine, Ghent University, 9000 Ghent, Belgium; (F.S.); (M.R.); (M.V.); (P.V.); (J.D.B.)
| | - Marine Vanhomwegen
- Center for Medical Genetics, Department of Biomolecular Medicine, Ghent University, 9000 Ghent, Belgium; (F.S.); (M.R.); (M.V.); (P.V.); (J.D.B.)
| | - Petra Vermassen
- Center for Medical Genetics, Department of Biomolecular Medicine, Ghent University, 9000 Ghent, Belgium; (F.S.); (M.R.); (M.V.); (P.V.); (J.D.B.)
| | - Jana Desloovere
- 4BRAIN, Department of Head and Skin, Ghent University, 9000 Ghent, Belgium; (J.D.); (R.R.); (L.E.L.)
| | - Robrecht Raedt
- 4BRAIN, Department of Head and Skin, Ghent University, 9000 Ghent, Belgium; (J.D.); (R.R.); (L.E.L.)
| | - Lars E. Larsen
- 4BRAIN, Department of Head and Skin, Ghent University, 9000 Ghent, Belgium; (J.D.); (R.R.); (L.E.L.)
- Institute Biomedical Technology, Ghent University, 9000 Ghent, Belgium;
| | - Máté I. Tóth
- Institute Biomedical Technology, Ghent University, 9000 Ghent, Belgium;
| | - Julie De Backer
- Center for Medical Genetics, Department of Biomolecular Medicine, Ghent University, 9000 Ghent, Belgium; (F.S.); (M.R.); (M.V.); (P.V.); (J.D.B.)
- Department of Cardiology, Ghent University Hospital, 9000 Ghent, Belgium
| | - Patrick Sips
- Center for Medical Genetics, Department of Biomolecular Medicine, Ghent University, 9000 Ghent, Belgium; (F.S.); (M.R.); (M.V.); (P.V.); (J.D.B.)
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23
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Chavarri F, Pinto M, Torres Y, Adrianzén V, de Guzmán IN, Esqueche E. Unconventional Surgical Intervention for Left Ventricular Pseudoaneurysm Associated With Staphylococcus aureus in a Pediatric Patient. World J Pediatr Congenit Heart Surg 2020; 11:509-511. [PMID: 32323616 DOI: 10.1177/2150135120905658] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Ventricular pseudoaneurysms are very unusual in children. A six-year-old child developed left ventricular pseudoaneurysm associated with methicillin-sensitive Staphylococcus aureus. The patient responded favorably to antibiotic therapy and ventriculoplasty through an unconventional surgery due to the constrictive pericarditis.
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Affiliation(s)
- Fernando Chavarri
- Pediatric Cardiovascular Surgery Service, Instituto Nacional Cardiovascular "Carlos Peschiera Carrillo," Lima, Peru.,Universidad Nacional Mayor de San Marcos, Lima, Peru
| | - Miguel Pinto
- Universidad Nacional Mayor de San Marcos, Lima, Peru.,Sociedad Científica de San Fernando, Lima, Peru
| | - Yeli Torres
- Universidad Nacional Mayor de San Marcos, Lima, Peru.,Sociedad Científica de San Fernando, Lima, Peru
| | - Valeria Adrianzén
- Universidad Nacional Mayor de San Marcos, Lima, Peru.,Sociedad Científica de San Fernando, Lima, Peru
| | - Ivan Niño de Guzmán
- Pediatric Cardiovascular Surgery Service, Instituto Nacional Cardiovascular "Carlos Peschiera Carrillo," Lima, Peru
| | - Eduardo Esqueche
- Universidad Nacional Mayor de San Marcos, Lima, Peru.,Pediatric Thoracic and Cardiovascular Surgery Service, Instituto Nacional de Salud del Niño de Breña, Lima, Peru
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24
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Hinton J, Hunter G, Dissanayake M, Hatrick R. Acute respiratory distress secondary to a huge chronic left ventricular pseudo-aneurysm. Echo Res Pract 2019; 6:K19-K22. [PMID: 31579523 PMCID: PMC6766756 DOI: 10.1530/erp-19-0018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Accepted: 08/29/2019] [Indexed: 11/08/2022] Open
Abstract
Pseudo-aneurysms are a rare, potentially life-threatening complication of a myocardial infarction. We present the case of a 45-year-old male who was brought to the emergency department in extremis and had a previous history of a late presentation inferior ST-elevation myocardial infarction treated percutaneously. Clinical examination revealed evidence of cardiogenic shock, pulmonary edema and a pulsatile epigastric mass. Chest X-ray demonstrated marked cardiomegaly and pulmonary edema. Urgent echocardiography confirmed the presence of a huge basal inferior wall pseudo-aneurysm with bi-directional flow. This was also associated with severe mitral regurgitation, due to posterior mitral annular involvement. The patient was transferred to the local cardiothoracic surgical unit where he underwent emergency repair of the pseudo-aneurysm and mitral valve replacement. Despite the surgery being complex he made a full recovery.
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Affiliation(s)
- Jonathan Hinton
- Cardiology Department, University Hospital Southampton, Southampton, UK
| | - George Hunter
- Cardiology Department, Western Sussex Hospitals NHS Foundation Trust, Worthing, UK
| | - Madhava Dissanayake
- Cardiology Department, Western Sussex Hospitals NHS Foundation Trust, Worthing, UK
| | - Rob Hatrick
- Cardiology Department, Western Sussex Hospitals NHS Foundation Trust, Worthing, UK
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