Subepicardial Aneurysm Research Articles

Subepicardial aneurysm with free wall rupture and its successful surgical intervention: a case report

BackgroundSubepicardial aneurysm (SEA) is an uncommon but potentially fatal complication of acute myocardial infarction (MI) associated with an increased risk of free wall rupture (FWR) leading to sudden death. We describe a rare case of a silent myocardial infarction complicated by SEA and subsequent FWR, resulting in cardiac tamponade.Case summaryA 68-year-old man with no previous chest symptoms presented with syncope. Cardiac computed tomography incidentally revealed a small aneurysmal cavity at the inferolateral wall of the left ventricle, which was overlooked on initial transthoracic echocardiography. Coronary angiography demonstrated a narrowed first obtuse marginal branch with coronary slow flow, suggesting that spontaneous recanalization of the occluded obtuse marginal branch induced SEA and subsequent FWR. The patient underwent an emergency left ventricular aneurysm repair. The post-operative course was uneventful, and the patient was discharged from the hospital on post-operative day 20.DiscussionThis case emphasizes the importance of prompt detection and surgical intervention for SEA. Subepicardial aneurysm should be suspected in patients with pericardial effusion and suspected MI. Cardiac computed tomography is not only useful in the detection of such cases but also facilitates the development of a successful surgical strategy.

A growing left ventricular aneurysm after myocardial infarction: pathological confirmation of subepicardial aneurysm.

A growing left ventricular aneurysm after myocardial infarction: pathological confirmation of subepicardial aneurysm.

Subepicardial aneurysm after blunt chest trauma: a life-saving complication?

Subepicardial aneurysm after blunt chest trauma: a life-saving complication?

A case of subepicardial aneurysm after acute myocardial infarction that was diagnosed by echocardiography in the emergency room and underwent successful surgery

A case of subepicardial aneurysm after acute myocardial infarction that was diagnosed by echocardiography in the emergency room and underwent successful surgery

Surgical repair of constrictive pericarditis with subepicardial aneurysm of the right ventricle

Surgical repair of constrictive pericarditis with subepicardial aneurysm of the right ventricle

O35-2 - A Case of Subepicardial Aneurysm That Was Diagnosed by Echocardiography in the Emergency Room and Underwent Successful Surgery

O35-2 - A Case of Subepicardial Aneurysm That Was Diagnosed by Echocardiography in the Emergency Room and Underwent Successful Surgery

The evolution of post-infarction dissecting hemorrhage into intramural hematoma and sub-epicardial aneurysm

The evolution of post-infarction dissecting hemorrhage into intramural hematoma and sub-epicardial aneurysm

Left Ventricular Rupture after Embolic Myocardial Infarction Due to Mitral Valve Endocarditis

We report a very rare case of a 43-year-old patient with fatal left ventricular subepicardial aneurysm rupture complicating embolic myocardial infarction due to mitral valve infective endocarditis.

EComment. Specific complications of apico-aortic conduit

We read with interest the article by Lund et al. regarding the Danish experience with the aortic valve bypass and we would like to comment on the complications of this procedure [1]. Potential complications include bleeding, chest infection, wound healing problems, myocardial infarction, benign arrhythmias, pulmonary embolism, endocarditis and sepsis. Specific complications include thrombus formation, possibly caused by stagnation due to flow competition (need for anticoagulation or antiplatelet treatment), as well as formation of pseudoaneurysm, subepicardial aneurysm or dehiscence of apico-aortic conduit (AAC) from the left ventricular (LV) apex, ventricular septal defect (VSD) at the tip of the apical connector, prosthetic valve structure failure or late apico-aortic conduit (AAC) obstruction [1-4]. We have described the complication of pseudoaneurysm formation following an AAC procedure in a 49-year old male with aortic valve stenosis [2]. The patient had undergone coronary artery bypass grafting (CABG) six years previously, via a median sternotomy and subsequent surgical repair of a juxta-ductal coarctation of the aorta through a left postero-lateral thoracotomy three months after his CABG. Six weeks after the AAC procedure, the patient was re-admitted due to chest pain, severe dyspnoea and uncontrolled hypertension, having stopped his anti-hypertensive treatment two weeks prior to admission. Computed tomography scan revealed a patent AAC with extensive dehiscence from the LV plus an associated pseudoaneurysm requiring urgent surgical intervention [2]. A modification of establishment of cardiopulmonary bypass (via femoral cannulation) due to inadequate arterial inflow as a bailout procedure was used with direct cannulation distal to the valve of AAC with a new arterial cannula. It was subsequently followed by removal of the LV connector and application of a new apical connector with its distal end re-anastomosed to the existing valved conduit [2]. The patient made a slow recovery and remains well over a 5-year period. Gammie et al., in their study of 14 patients with AAC, have reported on two patients with LV apical pseudoaneurysms. The first one presented with this complication on the 15th postoperative day with symptoms of haemodynamic instability and tamponade and the second one on the 8th postoperative day during his follow-up CT-scan [3]. The surgical treatment was consisted with direct pledgeted sutures and the one case 4 months later had recurrent apical pseudoaneurysm which was successfully treated with coils and thrombin (by percutaneous approach) [3]. Doi et al. have reported on a case of postoperative subepicardial aneurysm near the site of the proximal anastomosis of AAC in a 78-year old woman, which was repaired with pledgeted sutures [4]. In recent years, transcatheter aortic valve implantation (TAVI) has become favourable in patients who are not suitable candidates for conventional aortic valve replacement. It reduces the rates of death from any cause, repeat hospitalization and cardiac symptoms, despite the higher incidence of strokes and vascular events compare to standard therapy [5]. Even though the need for AAC has been markedly reduced, this method can be considered for patients with exclusion criteria for TAVI (unicuspid/bicuspid AV valve, aortic annulus size 25 mm, pre-existing prosthetic valve, bulky calcified AV leaflets in close proximity to coronary ostia, peripheral vascular disease, recent stroke and others) [5]. Conflict of interest: none declared.

Subepicardial aneurysm by venting catheter via the right superior pulmonary vein

Subepicardial aneurysm caused by a left ventricular venting catheter inserted from the right superior pulmonary vein is very rare. Generally, this type of aneurysm is a complication of acute myocardial infarction. We report a 76-year-old woman in whom a left ventricular aneurysm was shown by transthoracic echocardiography 3years after mitral valve replacement. She underwent left ventricular aneurysmectomy via the 4(th) left intercostal space. The left ventricular aneurysm was separated from the pericardium completely; therefore, this aneurysm was not thought to be pseudoaneurysm. The postoperative course was uneventful and the aneurysm was diagnosed as a subepicardial aneurysm from a histological examination.

Cardiac CT and MRI guide surgery in impending left ventricular rupture after acute myocardial infarction

We report the case of a 67 year-old patient who presented with worsening chest pain and shortness of breath, four days post acute myocardial infarction. Contrast enhanced computed tomography of the chest ruled out a pulmonary embolus but revealed an unexpected small subepicardial aneurysm (SEA) in the lateral left ventricular wall which was confirmed on cardiac magnetic resonance imaging. Intraoperative palpation of the left lateral wall was guided by the cardiac MRI and CT findings and confirmed the presence of focally thinned and weakened myocardium, covered by epicardial fat. An aneurysmorrhaphy was subsequently performed in addition to coronary bypass surgery and a mitral valve repair. The patient was discharged home on post operative day eight in good condition and is feeling well 2 years after surgery.

Echocardiographic progression of a subepicardial aneurysm after inferior myocardial infarction

A 62-year-old man presented to hospital with chest oppression. Coronary angiography revealed total occlusion of the right coronary artery and inferior myocardial infarction was diagnosed. He was treated by percutaneous coronary intervention with stenting for myocardial infarction. After four months, echocardiography revealed a huge aneurysm protruding below the inferior surface of the left ventricle. It was considered to be a pseudoaneurysm from the echocardiographic findings. The patient had no symptoms and he refused surgery, so progression of the aneurysm was monitored carefully. At seven months after revascularization, the aneurysm showed a marked increase in size, with a maximal diameter of 48 mm and orifice diameter of 22 mm. Accordingly, the patient agreed to undergo surgical excision. The aneurysm was resected and the defect was closed with a pericardial patch. Pathological examination revealed all of the myocardial elements in the aneurysm wall and thrombus in its lumen. In conclusion, this was a rare case of ventricular subepicardial aneurysm.

Subepicardial left ventricular aneurysm with an intraventricular narrow neck on the avascular apical area: Report of a case

A 48-year-old hiatus hernia patient with a history of an occasional epigastric burning sensation for the last 10 years presented with a new onset of chest pain in addition to the persistence of his other symptoms. An apical left ventricular aneurism was found on 64-slice computed tomographic angiography. Coronary angiography confirmed the diagnosis. No coronary lesion was found and the apical region of the left ventricle was avascular. He was operated on under the suspected preoperative possible diagnoses of left ventricular apical aneurysm, a pseudoaneurysm, or a diverticulum. Macroscopically, a subepicardial whitish aneurysmal region with a weakened wall was seen at the apical part of the left ventricle. The size of the lesion was 3 x 3 cm. The aneurysm did not have an extracardiac neck. When the aneurysm site was opened, a sclerotic aneurysm wall and a narrow neck below the incised sac was found; and the neck was communicating with the left ventricular cavity. The aneurysm site was resected and closed with a linear closure technique by using pledget-supported sutures. The termination of cardiopulmonary bypass was uneventful. The patient left the intensive care unit on the first postoperative day and was discharged from hospital on the 4th postoperative day. A subepicardial left ventricular aneurysm should therefore also be considered in the differential diagnosis of atypical chest pain.

Subepicardial Aneurysm Evaluated by Multiplane 2D and Real-Time 3D Volumetric Transesophageal Echocardiography

A 76-year-old man with a history of hypertension, dyslipidemia, and 90 pack-year smoking, presented to his primary care physician with complaints of worsening dyspnea. His ECG finding did not show any pathological Q-wave or ST-T abnormalities (Online Figure I). A 2D transthoracic echocardiogram revealed normal left ventricular (LV) systolic function with inferior and inferolateral wall motion abnormalities. A suspicious aneurysm was also noted (Figure 1). His adenosine stress nuclear perfusion images showed a moderate-sized area of ischemia or jeopardized myocardium involving the infero-lateral LV (Online Figure II). He underwent cardiac catheterization, which revealed an occluded right coronary artery and significant left-to-right collaterals (Figure 2). Left ventriculography revealed a hypokinetic basal inferior wall and an aneurysm (Figure 3, Movie I). A follow-up transesophageal echocardiogram was performed using an x7–2t …

Subepicardial aneurysm associated with ventricular tachycardia and thromboembolism in a patient with true ventricular aneusyrm due to coronary spasm

Subepicardial aneurysm associated with ventricular tachycardia and thromboembolism in a patient with true ventricular aneusyrm due to coronary spasm

Pseudo-pseudoaneurysm: A Rare and Unexplored Mechanical Complication of Myocardial Infarction

The mechanical complications of myocardial infarction are less frequently encountered in the current era of early revascularization. Complete myocardial rupture, although infrequent, is a potentially lethal complication. The pathology, prognosis, and treatment of complete myocardial rupture are well described in the medical literature. Incomplete cardiac rupture has been less well described, and its prognosis and treatment are less clear. Pseudoaneurysms, subepicardial aneurysms, and pseudo-pseudoaneurysms form the pathologic spectrum of incomplete cardiac rupture. Pseudoaneurysms involve complete myocardial rupture with containment by overlying pericardium, whereas subepicardial aneurysms involve aneurysmal outpouchings contained by epicardium. Pseudo-pseudoaneurysms are a subtype of subepicardial aneurysm consisting of diverticula contained by myocardial elements. Pseudo-pseudoaneurysms follow a variable course. Fibrous tissue may be deposited in the wall of the aneurysm allowing the patient to remain asymptomatic, or the myocardium may progressively dissect with resultant complete ventricular rupture. We describe a case of postinfarction pseudo-pseudoaneurysm that was diagnosed by echocardiography and managed conservatively.

Subepicardial aneurysm after apicoaortic bypass

In conventional aortic valve replacement for acquired aortic stenosis after previous coronary artery bypass grafting (CABG), damage to patent grafts remains one of the main intraoperative problems. In such cases apicoaortic bypass is an alternate method,1,2 but it has some characteristic complications that require special attention. There have been reports of postoperative pseudoaneurysm,3,4 but we experienced a case of postoperative subepicardial aneurysm near the site of the proximal anastomosis.

Oozing type of left ventricular rupture via subepicardial aneurysm diagnosed 5 months after myocardial infarction

A 71-year-old man visited our hospital complaining of increasing fatigue and exertional dyspnea. He had had severe epigastric pain for the past 5 months. On admission, chest radiogram showed marked cardiac dilatation and echocardiogram massive pericardial effusion with a small subepicardial aneurysm at the posterior wall of the left ventricle. An urgent pericardiocentesis removed 1300 ml of bloody effusion. The red blood cell count of the pericardial effusion was similar to that of the peripheral blood, and there were no abnormal findings on cytologic and bacteriological examinations. Coronary angiography showed a blunt occlusion of the mid-portion of the circumflex artery. Left ventricular angiogram revealed aneurysmal deformity of the left ventricular posterior wall. These findings suggested that an oozing type of left ventricular rupture via a subepicardial aneurysm had occurred after the onset of myocardial infarction (MI), resulting in massive accumulation of pericardial effusion. The patient is presently doing well without any clinical symptoms 18 months after pericardiocentesis. This is the first case report in which a subepicardial aneurysm with massive pericardial effusion was detected in the chronic stage of MI and successfully managed without surgical repair.

An example that presented giant aneurysm of the angina pectoris after percutaneous coronary intervention

We present the case of a 70-year-old woman who was admitted to our hospital with heart failure due to a giant left ventricular aneurysm involving the apex and severe mitral regurgitation. Three months before the hospitalization, percutaneous coronary intervention was performed for severe stenosis of the left main trunk. During the procedure, there were no abnormalities of distal coronary flow due to problems like embolization, and repeat coronary angiography, performed after stabilization of heart failure, showed no new significant stenosis. We diagnosed her condition as a subepicardial aneurysm by pathological examination of the resected specimen.

Subepicardial Aneurysm of Left Ventricle Adjacent to the Aortic Root

We report a case of subepicardial aneurysm, which developed in the anterobasal portion of the left ventricle wall and extended into the space between the aortic root and the right ventricular outflow tract (RVOT). Multidetector computed tomography (MDCT) demonstrates this rare aneurysm well.