Diagnosis Of Left Ventricular Pseudoaneurysm Research Articles

Usefulness of contrast echocardiography in the diagnosis of left ventricular pseudoaneurysm.

Usefulness of contrast echocardiography in the diagnosis of left ventricular pseudoaneurysm.

Left ventricular free-wall rupture, a potentially lethal mechanical complication of acute myocardial infarction: an unusual and illustrative case report

BackgroundThere are three major mechanical complications after acute myocardial infarction: left ventricular free-wall rupture, ventricular septum rupture and acute mitral valve regurgitation. The left ventricular free-wall rupture is a serious and often lethal complication following an ST elevation myocardial infarction. However, very rarely this rupture can be contained by the pericardium, forming a pseudoaneurysm.Case presentationWe report a case of a 66-year-old man with multiple cardiovascular risk factors and previous ST elevation myocardial infarction, complaining of atypical chest pain. His electrocardiogram was in normal sinus rhythm, with the presence of Q wave in inferior leads and T-wave inversion in lateral leads. A transthoracic echocardiogram showed a left ventricular pseudoaneurysm. In the coronary angiography, multi-vessel disease was found. On-pump CABG was performed and a posterolateral left ventricular giant pseudoaneurysm were observed. Due its “petrous” consistency it was impossible to perform an aneurysmectomy.ConclusionsThe diagnosis of left ventricular pseudoaneurysm can be difficult, as patients often present either asymptomatic or with non-specific symptoms attributed to other causes. A multimodality imaging diagnostic approach can be necessary. Immediate surgery is considered the treatment of choice because untreated pseudoaneurysms have a high risk of rupture leading to cardiac tamponade, shock and death.

Diagnosis of left ventricular pseudoaneurysm by cardiac CT angiography

We present a case of a patient with left ventricular pseudoaneurysm which was not noted on transthoracic echocardiography but incidentally detected by CT angiography in preparation of ablation therapy for ventricular tachycardia. The patient underwent successful surgical repair of the pseudoaneurysm. The case illustrates the utility of CT angiography for the diagnosis of this rare, but hazardous condition.

Three-dimensional echocardiography is a useful tool in the diagnosis of left ventricular pseudoaneurysm

Fig. 1. Transthoracic 3D echocardiographic imaging was performed by using Vivid 7 Dimension echocardiography equipment (GE, Vingmed, Horten, Norway). Pseudoaneurysm on the basal posterolateral wall and discontinuity of the myocardium (arrow heads) were shown in apical-to-basal transversely acquired slice of the left ventricle. MV, mitral valve; PsA, pseudoaneursym; RV, Fig. 2. Discontinuity of the myocardium in the pseudoaneurysm was also identified by contrast-enhanced multislice computerized tomography. LV, left ventricle; LA, left atrium; A, pseudoaneursym.

Echocardiographic Diagnosis of Left Ventricular Pseudoaneurysm in a Child after Cardiopulmonary Bypass

From the Cardiology Division, Children's Hospital of Pittsburgh. Reprint requests: Jose A. Ettedgui, MD, Cardiology Division, Children's Hospital of Pittsburgh, 3705 Fifth Ave at DeSoto St., Pittsburgh, PA 15213. 27/1/27712 nosis. The valve leaflets were dyplastic and therefore the pulmonary valve was excised. The right ventricular outflow tract was widened by use of a trans annular patch. During surgery, the left side of the heart was vented at the apex. The perioperative course was unremarkable, and on clinical examination 1 month after surgery the child had a normal precordial impulse with a short, grade IIIVI systolic ejection murmur along the upper left sternal border, followed by a short diastolic murmur of pulmonary insufficiency. At the routine 3-month postoperative evaluation the patient continued to be asymptomatic, but the physical examination had significantly changed. The apical.impulse was hyperdynamic and displaced laterally and associated with a thrill. Apart from the soft murmurs across the right ventricular outflow tract, there was an additional grade IV IVI systolic murmur

Advantages of colour flow imaging in the diagnosis of left ventricular pseudoaneurysm.

Eleven cases of left ventricular pseudoaneurysm in nine patients were studied by cross sectional echocardiography, conventional Doppler echocardiography, and colour flow imaging. In two patients recurrent pseudoaneurysms developed after cardiac surgery, three had acute rupture after myocardial infarction, two were the result of stab wounds, one was a late rupture of a true left ventricular aneurysm, one developed after surgical resection of a true left ventricular aneurysm, and two as a consequence of left ventricular venting. In all 11 cases the diagnosis was confirmed by angiographic or surgical information or both. The diagnosis was suspected clinically in only four cases. Cross sectional echocardiography alone confirmed the diagnosis in five cases. Neither pulsed wave Doppler nor continuous wave Doppler established the diagnosis when they were used without colour flow imaging in five and three cases respectively. In all 11 cases colour flow imaging showed flow in and out of the pericardial cavity at the defect site as well as the abnormal flow within the pseudoaneurysm. Subsequent use of pulsed Doppler showed a consistent "to and fro" flow pattern across the myocardial defect with characteristic respiratory variation of the peak systolic velocity. This unique intrapericardial flow pattern is diagnostic of a pseudoaneurysm. Colour flow imaging is a valuable addition to cross sectional and Doppler echocardiography, and is the best technique for detecting left ventricular pseudoaneurysms.

Two-dimensional echocardiographic identification of left ventricular pseudoaneurysm

Nine patients with proved left ventricular pseudoaneurysm after transmural myocardial infarction were studied by two-dimensional echocardiography. In all patients two-dimensional echocardiography successfully displayed the pseudoaneurysm. The unique two-dimensional echocardiographic characteristics of pseudoaneurysm include: (1) a sharp discontinuity of the endocardial image at the site of the pseudoaneurysm communication with the left ventricular cavity, and (2) the presence of a relatively narrow orifice in comparison with the maximum diameter of the pseudoaneurysm fundus; visualization of the maximum diameter of the pseudoaneurysm fundus frequently required a slightly different tomographic view than that required for demonstration of the orifice. The distinctive echocardiographic features of pseudoaneurysm in these patients and technical implications for optimal visualization are described. Most of the pseudoaneurysms we encountered and many of those previously described were located posteriorly. We found the use of an inferior angulated view modified from the standard apical four-chamber view extremely helpful in detecting the orifice in patients with posterior or posterolateral pseudoaneurysms. We conclude that two-dimensional echocardiography is an important technique for diagnosis of left ventricular pseudoaneurysm.

Diagnosis of left ventricular pseudoaneurysm by pulsed Doppler echocardiography

Diagnosis of left ventricular pseudoaneurysm by pulsed Doppler echocardiography

Noninvasive diagnosis of left ventricular pseudoaneurysm by radioangiography and echography

Noninvasive diagnosis of left ventricular pseudoaneurysm by radioangiography and echography

Noninvasive diagnosis of left ventricular pseudoaneurysm: Role of two dimensional echocardiography and radionuclide gated pool imaging

This report describes a case of left ventricular pseudoaneurysm diagnosed with two dimensional real time echocardiography. The two dimensional echocardiogram identified not only the pseudoaneurysmal sac but also the site of left ventricular rupture. When supplemented with radioisotope gated cardiac blood pool scanning, the noninvasive studies demonstrated combined true and false left ventricular aneurysms. Left ventricular pseudoaneurysm can be diagnosed using two dimensional echocardiography and nuclear imaging, permitting early operative intervention before fatal rupture.

Noninvasive Diagnosis of Pseudoaneurysm of the Left Ventricle

The echocardiographic, scintigraphic, angiocardiographic and autopsy correlations in a patient with left ventricular pseudoaneurysm are presented. Interruption of the echo of the left ventricular wall and radioisotope image of pseudoaneurysm and its communication channel are demonstrated for the first time. The striking similarity of the radioisotope image to the angiographic image is noted. This study suggests that echocardiography has capability to visualize left ventricular wall defects, such as the perforation seen in this case and radioisotope ventriculography is equivalent to the invasive contrast technique. Both of the methods seem to be safe and specific for the diagnosis of left ventricular pseudoaneurysm.

Ventricular Pseudo-Aneurysm Demonstrated by Multiple Gated Cardiac Imaging

The use of multiple gated cardiac imaging in the diagnosis of left ventricular pseudo-aneurysm is reported and the clinical and therapeutic implications are discussed. Complemented with myocardial perfusion imaging, it is the method of choice for screening patients following infarction or chest trauma who may develop this potentially treatable complication of myocardial necrosis.

Posterior left ventricular pseudoaneurysm. Angiographic-pathologic correlation.

A case of posterior left ventricular pseudoaneurysm is presented. Radiographically, this defect appeared as a double density overlying the inferior heart border. At ventriculography, a rounded chamber was seen posterior to the heart. Suggested etiology in this case was congenital weakness of the ventricular wall. Definitive diagnosis of left ventricular pseudoaneurysm requires left ventriculography.