Left Ventricular Pseudoaneurysm

Abstract

HomeCirculationVol. 111, No. 4Left Ventricular Pseudoaneurysm Free AccessReview ArticlePDF/EPUBAboutView PDFView EPUBSections ToolsAdd to favoritesDownload citationsTrack citationsPermissions ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toFree AccessReview ArticlePDF/EPUBLeft Ventricular PseudoaneurysmEchocardiographic and Intraoperative Images Demetrio Tallarico, Pier Andrea Chiavari, Pasquale Mollo and Giuseppe Campolongo Demetrio TallaricoDemetrio Tallarico From the Institute of the Heart and Large Vessels “Attilio Reale,” “La Sapienza” University of Rome, Italy. Search for more papers by this author , Pier Andrea ChiavariPier Andrea Chiavari From the Institute of the Heart and Large Vessels “Attilio Reale,” “La Sapienza” University of Rome, Italy. Search for more papers by this author , Pasquale MolloPasquale Mollo From the Institute of the Heart and Large Vessels “Attilio Reale,” “La Sapienza” University of Rome, Italy. Search for more papers by this author and Giuseppe CampolongoGiuseppe Campolongo From the Institute of the Heart and Large Vessels “Attilio Reale,” “La Sapienza” University of Rome, Italy. Search for more papers by this author Originally published1 Feb 2005https://doi.org/10.1161/01.CIR.0000153815.87329.1DCirculation. 2005;111:e35–e36A 44-year-old hypertensive woman with fever for 1 week and a history of apical myocardial infarction (1 month before) was transferred to our institution with chest pain and dyspnea. On physical examination, her heart rate was 115 bpm, her arterial blood pressure was 85/50 mm Hg, and peripheral cyanosis was present. The ECG showed sinus tachycardia and Q waves in the V1 to V2 leads. The serum concentrations of creatine phosphokinase-MB, troponin I, and myoglobin were within normal limits. A chest x-ray revealed an enlarged heart and a mild left pleural effusion. Two-dimensional transthoracic echocardiography (TTE) showed a large apical ventricular discontinuity (widest diameter 2.82 cm; Figure 1a) in communication with an echo-free space, suggestive of a huge pseudoaneurysm with a partially stratified thrombus (Figure 1b). A minimal pericardial effu-sion was present. The maximum internal end-systolic pseudoaneurysmal diameters were 11.27×10.45 cm (Figure 2a) with a ratio of orifice to cavity diameter of 0.25. Color Doppler showed flow passage from the left ventricle into the pseudoaneurysm (Figure 2b) and pulsed Doppler demonstrated systodiastolic flow through the false aneurysmal mouth (Figure 3a). Coronary angiography revealed a midportion occlusion of the left anterior descending artery; ventricular angiography was not performed because of the high risk of pseudoaneurysmal rupture. Surgery confirmed the diagnosis (Figure 3b), and the myocardial hole was repaired via endoventricular circular patch plasty. The postoperative course was uneventful. Download figureDownload PowerPointFigure 1. Two-dimensional TTE, apical 4-chamber modified view. a, Site of rupture with thin wall of large pseudoaneurysmal cavity (PAN) arising from left ventricular apex (a) and a protruding thrombotic mass (b). LA indicates left atrium; LV, left ventricle; and RV, right ventricle.Download figureDownload PowerPointFigure 2. Two-dimensional TTE images. a, Evident spontaneous echo-contrast inside pseudoaneurysm and maximum sac diameters. b, Color Doppler reveals communication between left ventricle and false aneurysm. Abbreviations as in Figure 1 legend.Download figureDownload PowerPointFigure 3. a, Pulsed Doppler across pseudoaneurysmal mouth shows bidirectional flow. b, Intraoperative finding; surgical probes indicate open cavity and pseudoaneurysmal neck (arrow).FootnotesCorrespondence to Demetrio Tallarico, MD, Via R. Zandonai 86, 00194 Rome, Italy. E-mail [email protected] Previous Back to top Next FiguresReferencesRelatedDetailsCited By Faustino M, Ranchordás S, Abecasis J, Freitas A, Ferreira M, Gil V, Morais C and Neves J (2016) Left ventricular pseudoaneurysm – a challenging diagnosis, Revista Portuguesa de Cardiologia (English Edition), 10.1016/j.repce.2015.09.027, 35:6, (373.e1-373.e6), Online publication date: 1-Jun-2016. Faustino M, Ranchordás S, Abecasis J, Freitas A, Ferreira M, Gil V, Morais C and Neves J (2016) Pseudoaneurisma ventricular esquerdo – um desafio diagnóstico, Revista Portuguesa de Cardiologia, 10.1016/j.repc.2015.09.008, 35:6, (373.e1-373.e6), Online publication date: 1-Jun-2016. Lee C, Lee D, Lim S and Kim H (2016) Anesthetic management during surgery for left ventricular aneurysm and false aneurysm occurring in stage: a case report, Korean Journal of Anesthesiology, 10.4097/kjae.2016.69.5.518, 69:5, (518), . Kopřiva K, Aschermann O, Mandysová E, Kmoníček P, Formánek P, Táborský M and Vymazal J (2007) Left ventricular lateral wall pseudoaneurysm, Cor et Vasa, 10.33678/cor.2007.159, 49:12, (454-458), Online publication date: 1-Dec-2007. February 1, 2005Vol 111, Issue 4 Advertisement Article InformationMetrics https://doi.org/10.1161/01.CIR.0000153815.87329.1DPMID: 15687117 Originally publishedFebruary 1, 2005 PDF download Advertisement SubjectsEchocardiographyMyocardial Infarction