Abstract
Pseudoaneurysm of the left ventricle is rare and may occur as a result of transmural myocardial infarction. The course of rupture after acute myocardial infarction varies from a catastrophic event, with an acute tear leading to immediate death (acute rupture), or slow and incomplete tear leading to a late rupture (subacute rupture). Incomplete rupture may occur when the thrombus and haematoma together with the pericardium seal the rupture of the left ventricle and may develop into a pseudoaneurysm. Early diagnosis and treatment is essential in this condition. Two-dimensional color Doppler echocardiography is the first-choice method for most patients with suspected left ventricular pseudoaneurysm (LVP) and suggests left ventricular rupture in 85% to 90% of patients. We report the case of an 87-year-old woman presenting with symptoms and findings of myocardial infarction and left ventricular free wall rupture with a pseudoaneurysm formation diagnosed by echocardiography and confirmed on CT, MRI, and NM. She received only intense medical treatment, because she refused surgery with a favorable outcome. After 24-month followup, she is in NYHA functional class II. The survival of this patient is due to the contained pseudoaneurysm by dense pericardial adhesions, related to her previous coronary bypass surgery.
Highlights
Left ventricular free wall rupture (LVFWR) in myocardial infarction (MI) is often fatal, and only a few patients may undergo operation
Left ventricular pseudoaneurysm (LVP) is formed when cardiac rupture is contained by adherent pericardium or scar tissue [4]
During a follow-up period of 24 months the patient continues to be in NYHA functional class II, and the 2D and 3D echo studies performed with a IE33 Philips Medical Systems confirmed a circular lateral wall rupture (Figures 6 and 7, and see supplementary material, movie clip Figures 6 and 7 available online at doi: 10.1155/ 2012/728602)
Summary
Left ventricular free wall rupture (LVFWR) in myocardial infarction (MI) is often fatal, and only a few patients may undergo operation. The cardiac rupture may be clinically undetected and lead to pseudoaneurysm [1,2,3]. Left ventricular pseudoaneurysm (LVP) is formed when cardiac rupture is contained by adherent pericardium or scar tissue [4]. Twodimensional echo is the first-choice method for patients with suspected LVP and suggests left ventricular rupture in 85% to 90% of patients [5]. The potential use of 3D echo in assessing the location and complex geometry of ventricular rupture site has been demonstrated [6].
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