Pseudoaneurysm Of Left Ventricle Research Articles

Hybrid repair of left ventricle pseudoaneurysm utilizing a transapical and transseptal approach

Mitral valve endocarditis complicated by peri-mitral annular destruction requires surgical intervention. We present a case where surgery was not an option. A 45-year-old man who developed an enlarging left ventricle pseudoaneurysm, left ventricle to left atrium fistula and red blood cell hemolysis as sequalae of mitral valve endocarditis was not a surgical candidate. Patient underwent a hybrid repair of left ventricle pseudoaneurysm via a transapical and transseptal approach. The body of pseudoaneurysm was coiled trans-apically whereas the neck of pseudoaneurysm was reached and coiled via a transseptal approach. The left ventricle to left atrium fistula was closed via an Amplatz muscular ventricle septal occluder. The pseudoaneurysm was fully obliterated, patient symptoms improved and was discharged with stable hemoglobin levels.

Basal pseudoaneurysm of the lateral wall of the left ventricle – case report

Left ventricle pseudoaneurysm is a rare but serious complication, most often secondary to myocardial infarction. It is associated with high mortality due to a significant risk of rupture. We present a case of a patient with a large basal pseudoaneurysm of the lateral wall of the left ventricle. The pseudoaneurysm is discovered from a chest radiography performed after a COVID-19 infection. The diagnosis is confirmed by echocardiography and ventriculography. The patient underwent surgical treatment by endoventricular patch plasty – Dor procedure. The patient in our case lacked the typical symptoms and ECG features, furthermore he had no history of myocardial infarction, cardiac surgery, trauma or endocarditis.

78 FOUR YEARS ECHOCARDIOGRAPHIC FOLLOW-UP OF A LEFT VENTRICULAR PSEUDOANEURYSM

Abstract Introduction Left ventricular pseudoaneurysm is a rare and often fatal complication of myocardial infarction. It has an incidence of 0,2-0,4% of all the STEMI and a very high mortality, particularly in the first month. Symptoms can vary from shortness of breath on exertion, orthopnea, chest pain, fatigue. At least 10% of patients do not present any symptoms and the pseudoaneurysm is diagnosed incidentally during a follow-up appointment. Signs include persistent ST elevation on EKG and its diagnosis can easily be made with a transthoracic echocardiogram and more in depth with a CT scan and a cardiac MRI. Its treatment is surgical, but the choice is up to the anesthesiologist and cardiothoracic surgeon, depending on patient's comorbidity and surgery risk. Surgical treatment has a high rate of death, reaching even the 37%. Background We present the case of a 74 years old patient with an history of chronic hypertension and cerebral vasculopathy, who sustained a STEMI in 2017. Urgent coronarography study was performed, but unfortunately the angioplasty treatment was unsuccessful and the left anterior descending artery could not be recanalized. Therefore, the patient was transferred to the cardiothoracic department in order to undergo bypass surgery: surgery was performed five days after, using left internal mammary artery to the left anterior descending artery and great saphenous vein to the first diagonal. Surgery went well with no complications; the post-operative period passed by without any complications and, after 15 days, patient was discharged with no complains. Two months later, he was admitted to intensive care unit of a hospital of our town, because of dyspnea (NYHA 3), peripheral edema, moderate-severe mitral insufficiency, moderate pleural and pericardial effusion. He underwent a CT-scan that showed “9×6,4 cm cavity with blood that seemed to have a connection with the postero-lateral wall of the left ventricle”. He also underwent a cardiac MRI that displayed a pseudoaneurysm with an endoluminal thrombus. After an accurate evaluation of the case, the Heart Team decided to do not perform surgery because of the high risk of the patient. Thence, we have been followed him with close echocardiographic exams for more than four years. Methods From March 2018 to September 2022, we have been followed the patient with complete echocardiographic follow-ups, done every three-six month. Results and conclusions Patient with left ventricle pseudoaneurysm due to an extensive myocardial infarction has been followed in our echo lab for more than 4 years. He has been stable during these years, NYHA II, in a good clinical and hemodynamical state.

Left Ventricle Pseudo Aneurysm in an Elderly Patient with Severe Coronary Artery Stenosis and Mitral Regurgitation

Left Ventricle Pseudo Aneurysm in an Elderly Patient with Severe Coronary Artery Stenosis and Mitral Regurgitation

When a delayed cardiology consultation leads to a massive left ventricle pseudoaneurysm: collateral effects of the COVID-19 pandemic

When a delayed cardiology consultation leads to a massive left ventricle pseudoaneurysm: collateral effects of the COVID-19 pandemic

Pseudoaneurysm of Left Ventricle as a Late Manifestation of Thoracic Trauma by Hoof Kick of a Horse

Pseudoaneurysm of Left Ventricle as a Late Manifestation of Thoracic Trauma by Hoof Kick of a Horse

P1257 Additional value of echocardiography in critical patient: a quick and effective tool to improve diagnosis and treatment

Abstract A 72 year-old woman with Hashimoto thyroiditis in replacement therapy and no known CV risk factors was admitted to the emergency department because of worsening asthenia, nausea, vomiting and fever unresponsive to antibiotic therapy. Two weeks before the admission, she had a syncopal episode preceded by intense chest pain for which she hadn’t seek medical help. At admission, the patient was unconscious and hemodynamically unstable with signs of shock (BP 80/50 mmHg, HR 120 bpm, lactate 6.11 mmol/L). She was promptly intubated and mechanically ventilated, and fluids and vasopressor treatment was administered. Lab tests showed moderate anaemia (haemoglobin 8.3 mg/dl), mild neutrophilia, elevated inflammatory markers (C-reactive protein 87 mg/dl) and troponin I (679 ng/L). An ECG showed sinus tachycardia and inferior Q waves. A thoraco-abdominal CT excluded pulmonary embolism and showed a suspect acute cholecystitis, suggesting a septic shock. However, a focused transthoracic echocardiogram in the emergency room showed a dilated and non-collapsing inferior vena cava, a severe mitral regurgitation and a very large rounded structure suggestive of left ventricle (LV) aneurysm/pseudoaneurysm, but it was inconclusive due to the poor acoustic window of the patient. The review of CT images also did not allow to make a clear diagnosis of LV aneurysm vs pseudoaneurysm. The patient was transferred in the ICU for further investigation; inotropes, vasopressors, blood transfusion and antibiotics were administered. A complete transthoracic echocardiogram (TTE) was performed to clarify the diagnosis between septic and cardiogenic shock. TTE revealed a large aneurysm (55x40 mm) of the inferior interventricular septum and inferior basal and mid LV segments, with a ventricular septal defect (VSD) with left-right shunt, a severe ischaemic mitral regurgitation and a severely dilated and dysfunctional right ventricle. Due to the suboptimal quality of TTE, an urgent transoesophageal examination (TEE) was done which revealed mobile masses attached on the tricuspid and the aortic valves suggestive of vegetations and confirmed the VSD at the level of a large inferoseptal LV aneurysm and severe ischaemic mitral regurgitation with no signs of papillary muscle or chordal rupture (Figure). Coronary angiography was performed, showing proximal occlusion of right coronary artery (likely embolic) with initial collateral circulation. Blood cultures were positive. The patient underwent cardiac surgery, which confirmed the diagnosis of endocarditis associated with VSD and LV aneurysm. The postoperative course was complicated by multiple organ dysfunction syndrome and death after 19 days of intensive care. Learning point in challenging cases with unclear diagnosis of septic versus cardiogenic shock, both TTE and TOE play a pivotal role showing a series of findings that can help clarifying the diagnosis and guide patient treatment in emergency settings. Abstract P1257 Figure

P713 An incidental finding of a completely thrombosed left ventricular pseudoaneurysm: what is the next step?

Abstract Introduction Left ventricular pseudoaneurysm is a rare complication of myocardial infarction. It is the result of ventricular rupture contained by the pericardial adhesions or thrombus. Although echocardiography is suitable as the initial method for diagnosis, multimodality imaging is often required in order to further characterize the pseudoaneurysm morphology and to plan the treatment. Case report A 56-year-old male patient with an old inferior myocardial infarction treated conservatively 6 years ago, was admitted in our department for atypical left laterothoracic pain. Three months before he had the same symptoms and an unexplained paracardiac mass was incidentally diagnosed by transthoracic echocardiography. At that time, he was evaluated by coronary angiography which showed no epicardial coronary artery stenosis. During admission, the ECG showed sinus rhythm, inferior myocardial scarring and right bundle branch block. The laboratory tests revealed cardiac enzymes within normal range, increased D-dimeri and elevated inflammatory markers. The echocardiography showed a nondilated left ventricle (LV) with preserved ejection fraction and akinesia of the inferolateral(IL) LV wall. Attached to the basal IL LV wall, an extensive mass was documented with an echogenic appearance and no color Doppler flow, suggesting a thrombosed pseudoaneurysm. A contrast enhanced computed tomography (CT) scan confirmed the diagnosis, but it was not able to establish whether the pseudoaneurysm was partially or completely thrombosed. For a more accurate morphologic and tissue characterization, a cardiac magnetic resonance imaging(CMR) was subsequently performed, that confirmed the presence of a completely thrombosed pseudoaneurysm, measuring 82x38mm. In this case, a conservative approach was initially suggested by the completely thrombosed chronic pseudoaneurysm (older than 3months and with no Doppler color flow). However, according to the literature a surgical approach should be considered when the pseudoaneurysm dimension is larger than 3 cm. Since the patient refused the surgical intervention, medical treatment was initiated with anticoagulants due to the high embolic risk, betablockers and angiotensin-receptor antagonists to maintain the blood pressure less than 120/80mmHg. At 1 month, his condition was stable. He will be reevaluated in 3 months, to monitor the possible pseudoaneurysm expansion. According to our knowledge, this is the first case of a completely thrombosed pseudoaneurysm described in the literature. Its echocardiographic, CT and CMR appearance is important for the differential diagnosis of all paracardiac masses (tumors, hiatus hernias, etc). Conclusion Completely thrombosed left ventricle pseudoaneurysm remains a challenging diagnosis since its echocardiographic appearance is atypical. Cardiac magnetic resonance imaging has a higher diagnostic yield and can provide important information that may influence the course of treatment. Abstract P713 Figure. LV Pseudoaneurysm-multimodality imaging

Left Ventricular Pseudo-Aneurysm after Ventricular Repair’s Rupture in Behcet Disease

A 21-year-old boy, with medical history of Behcet disease (BD) complicated by giant left ventricle pseudo aneurysm underwent in 2014 a surgical repair by patch closure, with good post-operative outcomes. He was admitted 3 years later with signs of congestive heart failure. Cardiac magnetic resonance (Figure 1, Movie S1 and S2) showed severe hypokinetic dilated cardiomyopathy with important systolic dysfunction (EF=20%) and ventricular rupture at inferior wall due to patch’s dehiscence leading to a giant left ventricle pseudo aneurysm (95 × 49 mm), The patient was managed conservatively

Early Endocarditis and Delayed Left Ventricular Pseudoaneurysm Complicating a Transapical Transcatheter Mitral Valve-in-Valve Implantation: Percutaneous Closure Under Local Anesthesia and Echocardiographic Guidance.

A 72-year-old man was referred because of suspected infective endocarditis. Fifteen years earlier, he had undergone mitral valve replacement with a 33-mm Hancock valve for severe mitral regurgitation. Three months ago, he presented with a first episode of congestive heart failure caused by severe mitral regurgitation reflecting degeneration of the bioprosthetic valve without sign of endocarditis. Because of a high surgical risk based on an estimated Euroscore I of 42.96% and The Society of Thoracic Surgeons (STS) score of 29% (main comorbidity is an advanced Parkinson disease), valve-in-valve implantation was planned. A 29-mm Edwards Sapien 3 (S3) balloon-expandable valve was successfully implanted through transapical puncture of the left ventricle (LV) after direct surgical exposure by mini thoracotomy. Patient was discharged 10 days after the procedure without complications. On his admission, the patient was febrile and examination revealed a purulent discharge at the site of thoracotomy. Transthoracic echocardiography (TTE) and transesophageal echocardiography showed a 15-mm mobile vegetation on the leaflet of the S3 (Movie I in the Data Supplement) and a pseudoaneurysm at the apex of the left ventricle (LVPA) flowing by a large apical defect (Figure 1; Movie II in the Data Supplement). Computed tomographic (CT) scanning confirmed the LVPA free from any thrombus and identified the surgical suture tip in its deep (Figures 1 and 2; Movie III in the Data Supplement). 18F positron-emission tomography demonstrated an uptake on the S3 and LVPA (Figure 2). Blood cultures were positive for Staphylococcus aureus . Antibiotherapy with co-trimoxazole for 6 weeks and clindamycin for 1 week was started, and a quick clinical and biological …

Left ventricular pseudoaneurysm as a fatal complication of purulent pericarditis

We report a case of a 48-year-old man with purulent pericarditis by Streptococcus viridans, despite aggressive treatment with antibiotics and partial pericardiectomy was complicated by left ventricle pseudo-aneurysm resulting in a fatal outcome. The case highlights the course of complicated purulent pericarditis and the use of noninvasive imaging for assessing early signs of pseudoaneurysm and its typical progression.

A huge left ventricular pseudoaneurysm manifesting as acute dyspnea

Pseudoaneurysm of the left ventricle (LV) is one of the mechanic complications of myocardial infarction. This rare complication mostly stems from inferior wall of the LV. The wall of pseudoaneurysm contains pericardium and/or scar tissue but not myocardium. Transthorasic echocardiography is commonly used in clinical practice and is usually sufficient to make a diagnosis of LV pseudoaneurysm. It is important to differentiate pseudoaneurysm from true LV aneurysm. Pseudoaneursym does not contain myocardial tissue whereas true LV aneurysm does. Pseudoaneurysm also has narrow neck unlike true LV aneurysm. Urgent surgical approach is indicated because of fatal rupture. Here we report a case report of pseudoaneurysm manisfesting with acute dyspnea.

Giant Left Ventricular Pseudoaneurysm after Acute Myocardial Infarction Secondary to Cocaine Use

The patient is a 19-year-old male that reported a 7-year history of regular cocaine presenting at this moment with dyspnea after moderate exertion, orthopnea and paroxysmal nocturnal dyspnea for 30 days. The echocardiogram and the cardiac magnetic resonance imaging showed a giant left ventricle pseudoaneurysm secondary to the usage of cocaine and previous myocardial infarction. The combination of these situations made this patient a unique case. We showed that the surgical treatment may be an option.

Left ventricle pseudoaneurysm as late postoperative complication of a large apical aneurysm

We report here the case of a patient with large left ventricular apical aneurysm incidentally discovered seven years after an inferior myocardial infarction. The aneurysm was successfully corrected by surgery. However, five months after surgery, the patient’s evolution was complicated by the sudden occurrence of a pseudoaneurysm. This case is complex and interesting because of several factors, including the incidental discovery, the atypical localization of an aneurysm secondary to the right coronary chronic occlusion, the size of the aneurysm, the preoperative differential diagnosis and the unusual late postoperative evolution.

Left Ventricle Pseudoaneurysm: Contribution of Multimodality Imaging to the Diagnosis

The left ventricle pseudoaneurysm is an anomaly of the left ventricle and is severed and joined with a pocket look. There may be secondary to a myocardial infarction, trauma, or surgical procedure. Sometimes the cause is not found. Complications are heart failure, arrhythmias, vascular embolism, and sudden death. The treatment is surgical only. The authors report the case of a black patient of 64 years old, without medical history, had seen to a deformation of the cardiac shadow in radiography. The left ventricle pseudoaneurysm and in situ thrombus are visualized in echocardiography and CT scan. The patient is waiting for heart surgery.

A Pictorial Review on the Role of 64-Slice HD MDCT in Detecting Post CABG Cardiothoracic Complications

Aims: The aim of this study is to have a pictorial review on the role of 64-slice multi-detector computerized tomography (MDCT) in detecting post coronary artery graft (GABG) cardiothoracic complications. Materials & Methods: During the period from November 2012 to December 2013, a prospective evaluation of 40 patients with suspected post-operative cardiothoracic complications underwent MDCT coronary angiography in our clinical radiology department. Informed consent was obtained from all patients and the study had institutional review board approval. Descriptive statistics were used to analyze the data. Results: There were 35 males and 5 females, their mean age ± (SD) of 57 ± 3.9 years. A total of 60 grafts were available for evaluation. Two patients could not be evaluated due to clip-artifacts and advanced atherosclerotic disease. Eleven patients showed occluded graft (9) at proximal and distal (2) anastomosis. Seven patients showed pericardial effusion and pleural effusion (8). Two patients had chest wall infection with retrosternal extension and associated mediastinal involvement. One patient showed aneurysm at the re-implanted coronary artery after Bentall procedure, another patient had postoperative myocardial infarction, one patient showed dissection of the ascending aorta, one patient pseudoaneurysm of left ventricle, two patients localized pericardial hematoma, two patients pulmonary embolism, and two patients showed pneumonia. All these complications occurred from 1-60 days from surgery. Conclusion: HD MDCT is an easy non-invasive technique which showed to be effective in diagnosis of most postoperative CABG cardiothoracic complications and is gaining more ground in difficult clinical situations.

Fistule coronaro-camérale acquise compliquée d’un pseudo-anévrysme ventriculaire

Coronary-cameral fistulas are usually congenital, rarely acquired; the complication of this anomaly with ventricular pseudoaneurysm is exceptional. We report a new case of acquired coronary-cameral fistula, occurred in a patient who had received a bypass graft and who had suffered from angina 1year after the surgery. On computed tomography coronary angiography, the fistula seems to communicate the first diagonal to a left ventricle pseudoaneurysm. Embolization of the fistula and filling of the pseudoaneurysm by neurocoil were successfully performed. The clinical and angiographic control after 3months showed symptoms improvement and absence of recanalization of the fistula.

EComment. Pseudoaneurysm secondary to native valve endocarditis

We read with great interest the paper by Sartipy et al. regarding the successful surgical management of a left ventricle pseudoaneurysm in a 76-year old patient with mitral valve endocarditis [1]. In this paper, we think that there may be a few matters to be clarified. To date, a handful of reports, mostly isolated case reports and small clinical series, have described successful management of left ventricle pseudoaneurysms [2-4]. What is remarkable in their report is that Sartipy et al. made no allusion in their discussion to a well-known and more frequent aetiology of left ventricle pseudoaneurysm, that is, post-traumatic left ventricular pseudoaneurysm [3]. Penetrating injuries into the heart or blunt thoracic trauma are the second most common cause of left ventricle pseudoaneurysm after extensive myocardial infarction. The possible mechanisms of pseudoaneurysm formation after chest injury include contusion of the myocardial wall, coronary artery injury with secondary myocardial necrosis, and intramyocardial dissecting haematoma. The authors stated that the possible mechanism for pseudoaneurysm formation in their patient was a coronary artery septic embolism. However, this cumbersome complication may also result from a local spread of the infected endocardium to the nearby myocardium. Myocardial abscesses, pseudoaneurysms of the ventricle, and free cardiac ruptures rarely complicate infective endocarditis. Rupture of the myocardial abscess is often fatal, but when the rupture is contained by scar tissue, this entity is known as a post-infective endocarditis pseudoaneurysm. Complete surgical resection with closure of the pseudoaneurysm neck remains the mainstay of therapy, can be curative, but carries a significant risk of mortality and morbidity. In a recently published retrospective study, Dudiy et al. [5] demonstrated that endovascular closure of the left ventricular pseudoaneurysm was a feasible and safe alternative for high-risk surgical candidates and they concluded that individualized management contingent on the anatomic characteristics of pseudoaneurysm and patient comorbidities were paramount. Both the diagnosis and management of pseudoaneurysm of the left ventricle have evolved from more invasive to less invasive strategies, paralleling the advent of sophisticated imaging tools and the development of transcatheter therapies. Conflict of interest: none declared.

Off -label use of Amplatzer devices in congenital heart disorders during childhood

Background Certain medical devices used to treat congenital cardiac lesions in the cardiac catheterization laboratory are used on an off -label and non-routine basis. This article discusses the non-routine use of Amplatzer medical devices.Methods In a retrospective study, from-11-2006 to-12-2011, Amplatzer devices used in our paediatric cardiology ward were reviewed.Results Children (n = 436) were catheterized to close their defects (438 defects) using Amplatzer devices. The mean age and body weight of the patients were 5.87 ± 4.2 years and 20.8 ± 13.6 kg. On-label devices were used for 421 patients (96.1%) and off -label devices for 17 patients (3.9%). The off -label use indications and used devices were the Amplatzer septal occluder (aortopulmonary window closure), the muscular ventricular septal occluder (perimembranous ventricular septal defect occlusion, patent ductus arteriosus occlusion, and right pulmonary artery to left atrium fi stulous connection closure), the vascular plug (coronary fi stula occlusion, left ventricle pseudoaneurysm occlusion, atypical patent ductus arteriosus occlusion, and anomalous pulmonary venous drainage occlusion), and the ductal occluder (ventricular septal defect occlusion). These devices were successfully implanted in exclusively extraordinary, diffi cult, or extreme cases.Conclusions The use of a medical device outside of its approved purpose is commonly referred to as “off -label use”. This study showed that the issue of off -label, non-routine use of devices exists in paediatric cardiology. Furthermore, the percutaneous closure of defects with non-routine Amplatzer devices is safe and eff ective, with a high success rate and a high follow-up term outcome.

Rare diagnosis of fibrous cardiac diverticulum in an adult followed by urgent surgical intervention

We describe the case of a 59-year old male patient with an acute onset of chest pain who was admitted to our unit with a suspected rupture of the left ventricle pseudoaneurysm, compressing the left atrium and the ascending aorta. Our urgent surgical intervention caused us to reject our initial diagnosis and revealed a cardiac diverticulum arising from the left ventricle outflow tract, spreading to the sub-valvular area compressing the left atrium, the ascending aorta and the pulmonary trunk, and compromising the aortic and mitral valve, causing moderate regurgitation. We removed the defect and replaced the aortic valve, eliminating the compression of the left atrium, aorta and pulmonary trunk. This article discusses the surgical technique for treating this ventricular diverticulum, its aetiology and the possible differential diagnosis in this case.