Large Left Ventricular Pseudoaneurysm Research Articles

Surgical techniques using an attached patch for large left ventricular pseudoaneurysm after inferior acute myocardial infarction.

We report a case of large left ventricular pseudoaneurysm after inferior acute myocardial infarction. Patch repair is commonly performed; however, only a few studies have described specific surgical techniques for left ventricular pseudoaneurysm repair of the inferior left ventricular wall. As an optimal repair technique for left ventricular pseudoaneurysm of the inferior left ventricular wall is lacking, we believe our technique is safe and effective in repairing this pathology.

Coronary Computed Tomography Angiography to Diagnose a Large Left Ventricular Pseudoaneurysm That Formed Rapidly After Myocardial Infarction.

Coronary Computed Tomography Angiography to Diagnose a Large Left Ventricular Pseudoaneurysm That Formed Rapidly After Myocardial Infarction.

Large Left Ventricular Pseudoaneurysm Presenting as an Embolic Stroke After a "Silent" Myocardial Infarction.

A 72-year-old woman with no history of coronary artery disease presented with an acute left middle cerebral artery stroke and was found to have a large left ventricular pseudoaneurysm measuring 8.7 × 7.6 cm and 2 large left ventricular thrombi, the source of her systemic embolization. Despite initial medical management, she developed refractory New York Heart Association functional class III heart failure, uncontrolled atrial fibrillation, and further enlargement of her pseudoaneurysm to 5.5 × 10.6 × 9.2 cm. She underwent urgent aneurysmectomy. Left ventricular pseudoaneurysms are rare and most commonly occur following an acute myocardial infarction when a ventricular free-wall rupture is contained by pericardium or thrombi. Historically, left ventricular angiography displaying a lack of an overlying coronary artery was the gold standard for diagnosis. Now, noninvasive imaging such as computed tomography, magnetic resonance imaging, and echocardiogram with ultrasound-enhancing agent, are reliable diagnostic tools. They can distinguish a pseudoaneurysm from a true left ventricular aneurysm using characteristic findings such as a narrow aneurysm neck, bidirectional doppler flow between the pseudoaneurysm and the left ventricle, and abrupt changes in the cardiac wall structures. Progressive dilation, wall thinning, and dyskinesis can result in refractory heart failure, arrhythmias, and thrombi formation from venous stasis. Pseudoaneurysms have a 30% to 45% risk of rupture and can be treated with left ventricular aneurysmectomy.

P130 A RARE CASE OF LARGE POST INFARCTION LEFT VENTRICULAR PSEUDOANEURYSM UNDERGOING CONSERVATIVE MANAGEMENT

Abstract Introduction Left ventricular pseudoaneurysm is a rare complication of myocardial infarction and its natural history is still unclear. Non invasive imaging improves detection ability and differential diagnosis with aneurysm. We present the case of large post infarction left ventricular pseudoaneurysm undergoing conservative management. Case Report A 81–years–old woman presented to emergency room complaining dyspnea and epigastric and right hemithoracic pain. Her past medical history included: chronic coronary syndrome, already undergoing CABG; recent inferior STEMI complicated with complete AVB, with ineffective RCA reperfusion attempt and bicameral pacemaker implantation; Paroxysmal AF in antithrombotic prophylaxis with DOAC. The ECG showed sinus tachycardia, HR 114 bpm, electro–induced ventricular complexes. Objectively, fine bilateral basal crackles were detected. Chest x–ray showed pulmonary congestion. The echocardiographic examination revealed: left ventricle with eccentric remodeling and severe depression of the contractile function (EF 35%), coarse neochamber in communication with the basal segment of the lower wall (D: 6.4 cm x 4.9 cm). The narrow neck, with a ratio <0.5 between inlet orifice diameter / neochamber diameter, suggested pseudoaneurysm. Working diagnosis of NSTEMI–ACS was made (usTnT peak: 344 pg / mL, NV: 0–15 pg / mL) complicated by heart failure. Progressive improvement in compensation was achieved through diuretic therapy. To improve diagnostic definition, cardio–synchronized chest CT with contrast medium was performed. The examination confirmed the voluminous neochamber, consistent with pseudoaneurysm, in correspondence with the mid–basal segments of the lower and inferior septal wall, with thinned walls and mass effect on the great cardiac vein, and highlighted the patency of the bypasses. The venous graft to OM was 5 mm distant from the posterior sternal surface. The case was discussed collectively in Heart Team, due to the high operative risk, the surgical option was rejected and a decision was made for conservative therapy. It was titled beta–blocker, ranolazine was introduced, heart failure therapy was implemented, introducing ARNI. The patient was discharged at home and is in follow–up at the outpatient clinic for heart failure. One month after discharge, she is in NYHA functional class II and she is asymptomatic for angor. The pseudoaneurysmatic dimensions are unchanged on echocardiographic control.

Correction to: Culprit of Unstable Angina: A Large Left Ventricular Outflow Tract Pseudoaneurysm.

Correction to: Culprit of Unstable Angina: A Large Left Ventricular Outflow Tract Pseudoaneurysm.

Left Ventricular Pseudoaneurysm: Unexpected Finding in a Patient Who Presented With Bacterial Endophthalmitis

A large left ventricular pseudoaneurysm was discovered in a patient who presented with bacterial endophthalmitis 1 year after medically treated Staphylococcus aureus mitral valve endocarditis. After medical therapy, the patient underwent cardiac surgery uneventfully. We present a rare finding of a pseudoaneurysm complicated with a very late ocular septic event. (Level of Difficulty: Advanced.)

363 Large Left Ventricular Pseudoaneurysm on Echocardiography, Successfully Treated With Conservative Management for 10 Years

We present an echocardiogram of an 80-year-old gentleman demonstrating a left ventricular (LV) pseudoaneurysm secondary to ruptured LV apex in the context of a previous myocardial infarction that occurred 10 years ago. He originally had a delayed presentation of anterior ST-elevation myocardial infarct (MI). Coronary angiogram demonstrated an occlusion of the distal left anterior descending artery and he was medically managed. His previous echocardiograms had misidentified it as a LV apical aneurysm. With conservative management, the patient has continued to do well and at time of the echocardiogram had NYHA class 1 symptomsView Large Image Figure ViewerDownload Hi-res image Download (PPT)View Large Image Figure ViewerDownload Hi-res image Download (PPT)View Large Image Figure ViewerDownload Hi-res image Download (PPT) LV pseudoaneurysm is a rare complication of MI when a rupture in the wall of the LV is contained within adherent pericardium. Sonographically, an abrupt interruption in the outline of the ventricular wall is seen and there is a contained cavity communicating freely with the LV through a narrow neck. True LV aneurysm is the discrete thinning of the ventricular wall with akinetic or dyskinetic wall motion causing an out-pouching of the ventricle. Clinically distinguishing the two pathologies is important as while LV aneurysms are normally medically managed, LV pseudoaneurysm have the propensity to rupture leading to cardiac tamponade, shock, and death and usually requires emergent surgical intervention. This case demonstrates an unusual case where a significant LV rupture is successfully managed conservatively over several years in a highly functional gentleman.

Large left ventricular apical pseudoaneurysm: a multimodal imaging approach guiding successful diagnosis and surgical management.

Large left ventricular apical pseudoaneurysm: a multimodal imaging approach guiding successful diagnosis and surgical management.

Is Expanding Heart Always Serious?

Left Ventricular Pseudo Aneurysm (LVPA) is a rare complication occurs in population that carries the risk. Clinical presentation of a large LVPA can be variable which make the diagnosis challenging. Given the high risk of death in such cases, high clinical suspicion in addition to the use of proper diagnostic modality may reduce the mortality rate & guide the management decision. Echocardiogram is considered the proper investigation tool to screen, diagnose the presence of LVPA & identify the high-risk feature of rupture. In this review will present catastrophic echocardiographic features in unusual clinical case presentation of a patient with large LV pseudo aneurysm presented with ischemic stroke & background of diabetes & hypertension.

A Silent Large Left Ventricular Apical Pseudoaneurysm Presenting as Congestive Heart Failure.

A Silent Large Left Ventricular Apical Pseudoaneurysm Presenting as Congestive Heart Failure.

Spontaneous closure of a large left ventricular pseudoaneurysm

Spontaneous closure of a large left ventricular pseudoaneurysm

Unsuspected large left ventricular pseudoaneurysm: rapid bedside diagnosis by contrast-enhanced echocardiography: Figure 1:

An asymptomatic 72-year-old man with cardiomegaly was referred to our centre for assessment. His medical history comprised metastatic colonic cancer and granulomatosis with polyangiitis. Transthoracic echocardiography was performed. In the apical four-chamber view, a large cavity was identified adjacent to the apex, measuring 45 × 54 mm (Fig. 1A and Supplementary Video 1). All apical segments of the left ventricle were thin and akinetic. On colour Doppler, bidirectional blood flow due to swirling of blood was observed within the cavity (Fig. 1B and Supplementary Video 2). Contrast-enhanced echocardiography established the site of rupture within the thinned apical wall of the left ventricle, measuring 15 mm in width, communicating freely with a large, thrombus-free pseudoaneurysm (Fig. 1C and Supplementary Video 3). Cardiovascular magnetic resonance imaging confirmed the finding of an apical pseudoaneurysm (Fig. 1D and Supplementary Video 4). Late gadolinium enhancement was limited to the apical segments in a transmural distribution. The remaining segments of the left ventricle were functioning and viable with no evidence of inducible ischaemia. Coronary angiography demonstrated unobstructed arteries. Figure 1: (A) Transthoracic echocardiogram; four-chamber view. (B) Colour Doppler showing bidirectional flow of blood within the left ventricular pseudoaneurysm. (C) Contrast-enhanced transthoracic echocardiogram, zoomed on the left ventricular pseudoaneurysm. ... In this case, the likely primary event was an unrecognized myocardial infarction, followed by ventricular wall rupture contained within pericardial tissue. Possible mechanisms for the myocardial infarction include acute coronary artery occlusion with spontaneous recanalization, coronary thromboembolism and coronary vasculitis. This patient's case was discussed in a multidisciplinary team meeting. The consensus view was that the risk of rupture of the pseudoaneurysm was small. Furthermore, the patient's survival was estimated to be 1 year due to his metastatic colonic cancer. Consequently, medical treatment was advised. The natural history of left ventricular pseudoaneurysms is not known. If left untreated, left ventricular pseudoaneurysms predispose to ventricular rupture, thromboembolism, compression of local structures and arrhythmia. Most pseudoaneurysms require surgical intervention [1] or percutaneous closure [2]. When a left ventricular pseudoaneurysm is chronic, there are limited outcome data to guide the need for surveillance and timing of intervention. This case illustrates the value of contrast-enhanced echocardiography as a low cost adjunct to complex imaging modalities, to rapidly distinguish left ventricular pseudoaneurysms from other cardiac pathology. No ethical approval is required. The patient provided written consent. R.S. is nominated as the guarantor of this work.

A large left ventricular pseudo-aneurysm

A large left ventricular pseudo-aneurysm

The role of multidetector computed tomography for detecting aortic root pseudoanerysms complicating infective endocarditis

Echocardiography is the mainstay imaging technique for detecting infective endocarditis vegetations but may struggle to detect and characterise complicating features. There is increasing interest in the use of multidetector computed tomography (MDCT) as an adjunct to echocardiography, especially where there is concern for abscess or pseudoaneurysm formation. We present the case of a 70-year-old male with bio-prosthetic aortic valve endocarditis complicated by a large infected left ventricular outflow tract pseudoaneurysm which was diagnosed using MDCT angiography. Radiologists and clinicians should be aware of the emerging role of MDCT in this setting in order to advise and direct an appropriate imaging strategy.

Faux anévrisme du ventricule gauche du sujet jeune : à propos de trois cas

Pseudoaneurysm of the left ventricle is a rare late complication of myocardial infarction. So-called non-coronary forms have been described in young people. In this context, we report three cases. Mr. M.B., aged 20, consulted for chest pain associated with palpitations. Cardiovascular examination found a pulsatile, expanding precordial bulging and a mesocardiac systolo-diastolic murmur. We noted a sinus rhythm with ventricular extrasystoles on ECG. The chest radiograph showed cardiomegaly and aneurysmal deformation of the left lower heart border. Doppler echocardiography showed a large left ventricular apical pseudoaneurysm. Mrs. O.B., aged 23, was admitted for biventricular heart failure and in whom the examination found a systolic murmur in the apical area. ECG showed a regular sinus tachycardia, left atrial and ventricular hypertrophy. The chest radiograph showed cardiomegaly and aneurysmal deformation of left middle and lower heart borders. Doppler echocardiography showed a large left ventricular apical pseudoaneurysm. Mr. I.S., aged 24, admitted for the management of congestive heart failure. The patient had non-specific laboratory inflammatory signs, a sinus tachycardia and extrasystoles on the ECG. Chest radiography showed a discontinuation at the posterior arch of the sixth rib, a cardiomegaly and a neurismal dilatation of the left lower heart border. Doppler echocardiography showed a large apical pseudoaneurysm of the left ventricle.

Hemolytic Hyperbilirubinemia After Percutaneous Device Closure of Left Ventricular Pseudoaneurysm: A Disregarded Complication

Surgical repair of a left ventricular pseudoaneurysm is challenging. Percutaneous closure with an AMPLATZER Septal Occluder (AGA Medical Corporation, Golden Valley, MN) has evolved to be an effective alternative to conventional surgery with less complication. We report a case of severe hemolytic hyperbilirubinemia and acute renal failure after percutaneous left ventricular pseudoaneurysm endoprothesis repair, which required conventional surgical repair through a left thoracotomy to treat this complication. The rationale and results of such an off-the-label usage of AMPLATZER Septal Occluder were reexamined. Residual leakages were not rare findings in the reviewed literature. The indications for this approach should be individualized.

A large left ventricular pseudoaneurysm evaluated with multimodality cardiac imaging

Rarely, the rupture of the free wall of the left ventricle is contained by an adherent pericardium, creating a pseudoaneurysm. This clinical finding calls for emergency surgery. However, true aneurysms, if no ruptures are detectable and myocardium wall integrity is confirmed, can often be managed medically. Therefore, the accurate diagnosis of these conditions is clinically important. In this report, we present a case of large left ventricular pseudoaneurysm evaluated with multimodality cardiac imaging.

Left Ventricular Pseudoaneurysm

Left ventricular (LV) pseudoaneurysm is rare in children. This report describes the case of a 2-year-old previously healthy girl who was diagnosed with endocarditis and underwent resection of a large mitral valve vegetation from the posterior mitral leaflet. One month after this surgery, she was diagnosed with a large LV pseudoaneurysm based on echocardiography performed during routine outpatient follow-up. Cardiac surgery was performed urgently to address the pseudoaneurysm, given its potential to rupture spontaneously. This case emphasizes the need for a close follow-up of children with endocarditis for development of pseudoaneurysms, which is a rare but potentially fatal complication of endocarditis.

Transcatheter closure of a large left ventricular pseudoaneurysm using an Amplatzer Vascular Plug 4 and stenting of the inferior caval vein in a child

Left ventricular pseudoaneurysm is especially rare in childhood, and its main treatment option should be surgery. We describe the case of a 9.5-year-old boy who first underwent mitral vegetation excision and then an unsuccessful pseudoaneurysm operation. Owing to pseudoaneurysmal sac dimensions, inferior caval vein syndrome developed. We delivered the Amplatzer Vascular Plug 4 into the pseudoaneurysm and treated the inferior caval vein syndrome with a bare Cheatham-Platinum stent. The patient was asymptomatic at the last follow-up.

Left ventricular pseudoaneurysm after apicoaortic bypass

1010-7940/$ — see front matter # 2011 European Association for Cardio-Thoracic S doi:10.1016/j.ejcts.2011.04.036 A 78-year-old man had severe aortic stenosis. Because of ascending aorta calcification and previous coronary artery bypass graft, we performed apicoaortic bypass through left thoracotomy. An enlarging mass was noted (Fig. 1). Echocardiography and computed tomography revealed a large left ventricular pseudoaneurysm (Fig. 2). Re-operation was performed smoothly through re-thoracotomy to repair the tear.