Ventricular Pseudoaneurysm Research Articles

Abstract 12152: Recurrent Cerebrovascular Accidents Following Myocardial Infarction With Mechanical Rupture

Background: Mechanical complications of myocardial infarction (MI), including ventriculoseptal ruptures (VSR) and pseudoaneurysms, are potentially life-threatening events but are less common in the era of timely primary percutaneous coronary interventions. Rare case reports describe MI complicated by VSR requiring repair, with delayed left ventricular (LV) pseudoaneurysm formation from the site of VSR repair. We present an atypical manifestation of one such case. Case Presentation: A 55-year-old male was admitted with late presentation inferior MI complicated by inferior VSR, requiring extracorporeal membrane oxygenation and surgical repair. Five months later, he was admitted with left upper extremity weakness and sensory loss. Brain imaging revealed an acute infarct of the precentral gyrus and subacute punctate infarcts of the centrum ovale. He was referred for cardiac magnetic resonance imaging, which revealed a large 6.8x4.9 cm inferior LV pseudoaneurysm containing a large thrombus (Figure 1). He underwent urgent surgery revealing a left ventricular inferior wall defect (Figure 2) and pseudoaneurysm with large mural thrombus. The pseudoaneurysm was successfully repaired via Dacron patch placement and thrombus evacuated. Conclusion: Although less common in the modern era, mechanical complications are possible after severe MI. Clinicians should be aware of the potential for atypical manifestations of these complications, including cardioembolic events that can arise within large pseudoaneurysms.

Abstract 9492: Transcatheter Amplatzer Occluder Device Closure of Post-Myocardial Infarct Pseudoaneurysm: A Case Report

Introduction: Left Ventricular Pseudoaneurysm (LVP) is defined as cardiac wall rupture leading to a formation of wall with thrombus, pericardial, or scar tissue functioning as a pouch for blood. A loculated pericardial effusion (LPE), and right ventricular pericardial fistula (RVPF) have never been reported in literature. Here, we report the first case of a 70 year old male who developed a LVP, LPE, and RVPF. Case Description: A 70 year old male with a past medical history of hypertension presented with inferior wall STEMI. Cardiac catheterization demonstrated left anterior descending (LAD) with 80% occlusion and right coronary artery (RCA) with 100% occlusion. Percutaneous intervention of RCA with aspiration thrombectomy and two drug eluting stents was performed. Echocardiogram the following day demonstrated a LVP. A transesophageal echocardiogram (TEE) demonstrated LVP near the mid-inferior interventricular septum draining into the pericardial space, and LPE from the apical inferior left ventricle (LV) extending to the apical cap of the right ventricle (RV). Computed tomography angiography (CTA) demonstrated a multiloculated collection at the inferior septal aspect of LV contained by the pericardial space. Patient was a high risk for surgery. LVP was closed via a 24 mm atrial septal defect (ASD) occluder device. Intraoperative TEE demonstrated an ASD occluder device at the mid inferior septum at the location of the LVP neck with minimal residual flow into the LPE and a fistula connecting the LPE space with RV. RVFP was managed conservatively. LAD was managed medically. Patient was discharged home safely on guideline directed medical therapy. Discussion: LVP rate is 0.0026% following myocardial injury. It is reported that untreated LVP have a rupture risk of about 30% and a mortality rate of 50%. Prompt treatment is required to prevent mortality. Surgical management is the standard of care. A multidisciplinary heart team deemed the patient a high risk. Therefore, transcatheter treatment was sought in the patient above. Conclusions: Surgical treatment is standard of care for LVP, but transcatheter wall closure with an ASD device is a promising technique not only for high-risk surgical candidates such as above, but as a gold standard of treatment for LVP.

Left ventricular pseudoaneurysm and the utility of non-contrast coronary artery calcium scan in differentiating acute versus chronic bleed

A Left Ventricular Pseudoaneurysm (LVP) forms when cardiac rupture is contained by pericardium or scar tissue [1]. Ventricular pseudoaneurysms differ from true aneurysms since they do not contain the endocardium or myocardium. LVPs can result from myocardial infarction, cardiac surgery, infection, or trauma [1]. The clinical presentation for ventricular pseudoaneurysms varies. Most notable presentations are chest pain, dyspnea, sudden cardiac arrest, congestive cardiac failure, tamponade, embolism, and syncope.

Robotic Redo Mitral Valve Replacement and Atrioventricular Groove Pseudoaneurysm Repair.

We report the use of robot-assisted right thoracotomy in the management of a patient who presented with acute-on-chronic congestive heart failure, associated with a contained atrioventricular dissection and 2 prior mitral valve replacements. Our patient had evidence of a contained rupture, as represented by preoperative cross-sectional imaging. The anatomic sequela from this was a ventricular pseudoaneurysm, which was likely survivable due to adhesions from prior operations buttressing the margins of the defect. Expansion of the pseudoaneurysm likely contributed to the dehiscence of the prosthesis. Our case illustrates an unprecedented resolution of a serious complication, managed effectively and efficiently by a robot-assisted procedure. With a successful outcome of totally endoscopic and robot-assisted repair, we demonstrate the versatility of minimally invasive techniques in addressing complicated anatomy as well as a surgical field scarred by multiple prior surgeries.

Left ventricular outflow tract pseudoaneurysms and severe paravalvular aortic regurgitation treated by percutaneous approach in a Marfan syndrome patient

A 66-year-old male with a history of Marfan syndrome and resolved infective endocarditis was found to have shortness of breath after a previous aortic valve replacement in 2010. Several severe paravalvular leaks were seen on imaging, and left ventricular outflow tract pseudoaneurysms were identified as the cause of his symptoms which warranted treatment. Due to this patient’s risk of surgical intervention, a retrograde transaortic approach was used.

Right ventricular pseudoaneurysm repair and fibrin pericardiectomy after a fall from height in a young male patient

Right ventricular pseudoaneurysms are rare in the literature. Patients may have complaints such as shortness of breath, fatigue, and palpitations, as well as signs such as ventricular arrhythmias and hypotension. In addition to a good physical examination and anamnesis, transthoracic echocardiography, transesophageal echocardiography, computed tomography, computed tomography angiography, magnetic resonance imaging, magnetic resonance angiography, scintigraphy, and ventriculography can also be used for diagnosis. The certain treatment of right ventricular pseudoaneurysms is surgical aneurysmectomy and repair. Herein, we present the diagnosis and management of a 32-year-old male patient with a right ventricular pseudoaneurysm, which was diagnosed 20 years after a fall from height.

Left Ventricular Pseudoaneurysms Discovered Early After Acute Myocardial Infarction: The Surgical Timing Dilemma.

Left ventricular pseudoaneurysm is a rare disease; it is defined as a ventricular rupture contained by epicardium, pericardial adhesions, or both. It most frequently occurs as a complication of acute myocardial infarction. Surgical treatment is recommended for pseudoaneurysms that are large or symptomatic and for those discovered less than 3 months after myocardial infarction. We report our experience with 2 patients who had left ventricular pseudoaneurysms discovered less than a week after inferior myocardial infarction. Both patients were middle-aged men with right coronary occlusion in whom the diagnoses were established by echocardiography during the first week after infarction. Because both patients were clinically stable, we opted to defer surgery until scarring could facilitate correction; this decision was based on a review of the literature showing that in-hospital mortality is higher with early surgery. The patients were monitored closely in the intensive care unit and were prescribed β-blockers and vasodilators. Both patients underwent left ventricular patch reconstruction with exclusion of the pseudoaneurysm and posterior septum; both received moderate inotropic support and prophylactic intra-aortic balloon pump assistance. Their postoperative courses were uneventful. In 5 prior reports describing 45 patients (13 with acute pseudoaneurysm [≤2 wk after infarction] and 32 with nonacute pseudoaneurysm), in-hospital mortality was 61.5% for patients in the acute group and 15.6% for the nonacute group (P = .0066). We recommend that clinicians consider deferring surgery for patients with stable acute left ventricular pseudoaneurysm to reduce the risks associated with early repair.

Left Ventricular Pseudoaneurysm: A Rare Cause of Chest Pain to Keep in Mind

A man in his 80s presented with sharp central chest pain, diaphoresis, and dyspnea. He had a remote history of coronary artery bypass graft. Results of the physical examination were unremarkable, and initial vital signs were stable. Electrocardiogram was unrevealing. Troponins were elevated and flat. He was initiated on intravenous nitroglycerin, after which his symptoms resolved. However, his blood pressure decreased to a minimal systolic of 76 and diastolic of 50 mm Hg. Because of the resolution of his symptoms, immediate angiography was deferred, and the patient was admitted to the cardiac intensive care unit. Transthoracic echocardiography (TTE) showed a loculated pericardial fluid collection adjacent to the anterolateral left ventricular (LV) wall (Figure; Video 1, available online at http://www.mayoclinicproceedings.org). Contrast TTE showed extension of the contrast from the main LV cavity to the adjacent pericardial cavity, consistent with pseudoaneurysm (Figure; Video 2, available online at http://www.mayoclinicproceedings.org). Computed tomography angiography of the thoracic aorta confirmed LV myocardial rupture along the anterolateral wall with active extravasation of contrast (Supplemental Figure 1A-D, available online at http://www.mayoclinicproceedings.org). The patient’s hospital stay was complicated by acute kidney injury. In the setting of increased risk for dialysis, he opted for conservative management. He remained hemodynamically stable, and pericardiocentesis was not indicated. He was discharged 1 week later. Predismissal TTE redemonstrated the contained LV anterolateral wall rupture with systolic and end-diastolic flow through the myocardial defect (Supplemental Figure 2; Video 3, available online at http://www.mayoclinicproceedings.org). He did well after discharge and died 4 years later of metastatic bladder cancer. Left ventricular pseudoaneurysms develop when LV free-wall rupture is contained by adherent pericardium or scar tissue and is most commonly secondary to myocardial infarction.1Frances C. Romero A. Grady D. Left ventricular pseudoaneurysm.J Am Coll Cardiol. 1998; 32: 557-561https://doi.org/10.1016/s0735-1097(98)00290-3Crossref PubMed Scopus (0) Google Scholar Mortality rate is high both with surgically (23%) and medically (48%) managed patients. Our patient’s previous cardiac surgery was thought to provide him with protection against complete rupture owing to scar tissue formation along the pericardium. The authors have no competing interests. eyJraWQiOiI4ZjUxYWNhY2IzYjhiNjNlNzFlYmIzYWFmYTU5NmZmYyIsImFsZyI6IlJTMjU2In0.eyJzdWIiOiIxNTQxZDIwOGFjOGU1NzExNTdlMjNhZjAyYmQzOWFjZiIsImtpZCI6IjhmNTFhY2FjYjNiOGI2M2U3MWViYjNhYWZhNTk2ZmZjIiwiZXhwIjoxNjcyMjg1NzkzfQ.bVK6mgeslM0bvj2ghgDzATVaMK2nN-hvkaaOINrhzerjUTY0BhHMM0RiEzxLzEbBfhrwaelJakGbXXQRNll3c1A4XIQPAMOuOb2WwBwZngrk3sZqt9PQ4-QR1521dLqyo87FedzewHEVHQp1u1-hU63njZ80S64gIww7AGwvm1GYVyG_PUqN2dsULzDkhx0u4N5mSlj1ic-GJziWbDQxyp_vNNXowt-C79lK4_irrwGt4gwiXrVTBjmVW7EKxw5UnOPiqxuUal_anvunu52uzNW3lrhjfMSIvZiK_HwBXn1MpYIpEXuY1maXiO04cZRMuJsbkyi_csiLCsenlZMhWQ Download .mp4 (0.63 MB) Help with .mp4 files Supplemental Video 1eyJraWQiOiI4ZjUxYWNhY2IzYjhiNjNlNzFlYmIzYWFmYTU5NmZmYyIsImFsZyI6IlJTMjU2In0.eyJzdWIiOiJmNmU1ZDFjYzFjN2ZjM2EwMWM5NDQwZTRiMmVjZTQwMyIsImtpZCI6IjhmNTFhY2FjYjNiOGI2M2U3MWViYjNhYWZhNTk2ZmZjIiwiZXhwIjoxNjcyMjg1NzkzfQ.Llq0S-_MHJRqyeGeS8Jl1MGMOD3jHXaMnSq2_kq2VhClHCQx7UQu2w1bavnJDzW-urKRKWcnlXxIP6c8ScTvUdDnqtsubhEVrzHW2JY3Z0uOy9wcg6B_njlmvDJ7DjHkNV_Wg1UShZnAe4D0BMcCn1xyOhNhnmdAmi6V4c4-scHYs1f39hzgdjf9w5F7dKcuSbIKlkrjtEY_qTeY2cR1xdts7_cPrryda-lMKtQI_u3_dJVyf6V98uOfmi83dlBu4IKiMAQTQqVhegEmZZMM2zW5oeMHuoJNa_Aucg2BGVfu0eSp_755fOFZplx8a3eJo6XSzsB117uy6si2bN1Rig Download .mp4 (1.19 MB) Help with .mp4 files Supplemental Video 2Supplemental Figure 2Predismissal transthoracic echocardiography demonstrating contained left ventricular anterolateral wall rupture with systolic flow through the myocardial defect (green arrow).View Large Image Figure ViewerDownload Hi-res image Download (PPT)eyJraWQiOiI4ZjUxYWNhY2IzYjhiNjNlNzFlYmIzYWFmYTU5NmZmYyIsImFsZyI6IlJTMjU2In0.eyJzdWIiOiI0ZmEyNTIzYzc5NzdlNjg0NTUzNmI2MDcxMDM2ZTcxNSIsImtpZCI6IjhmNTFhY2FjYjNiOGI2M2U3MWViYjNhYWZhNTk2ZmZjIiwiZXhwIjoxNjcyMjg1NzkzfQ.CLfwOf7c_tQ5ApbvTOhJiynY9JIChxJ0Ho88bUeccmwEp0wB49X9Fp6UwMS-Qib5WLnv2_nCIlFxES7Q4iG6BIz_EeZA793g_oji_oHVeYoGnFheqPblch42qUSdCpa-xMBwZcZ8c-gzQhvpS3I5zNtDduAhHgYApS4ZAabBZ_mf8tP7br0YwC9bwnbMsA_bSc96LWkKylKVzz_u0U1GrNP9PsBT48qp0Gx1eVFZH__eZ7YuQ8oU67aqRZrGIWmPiVzth5eA72Hj4DjTmNP5QgIm_xzs2b015kbpEQSmn5UIU2iD4DPfCHR1S9woNUB6-DHnncT-Dl6Z2dLsB5WWeA Download .mp4 (0.57 MB) Help with .mp4 files Supplemental Video 3

Percutaneous closure of left ventricular pseudoaneurysm. How would I approach it?

Percutaneous closure of left ventricular pseudoaneurysm. How would I approach it?

Percutaneous closure of left ventricular pseudoaneurysm. Case resolution

Percutaneous closure of left ventricular pseudoaneurysm. Case resolution

Staphylococcal Myocardial Abscess Eroding the Submitral Left Ventricular Free Wall Disguising as Left Ventricular Pseudoaneurysm in a Toddler

Staphylococcal Myocardial Abscess Eroding the Submitral Left Ventricular Free Wall Disguising as Left Ventricular Pseudoaneurysm in a Toddler

Unruptured left ventricular pseudoaneurysm after silent myocardial infarction with severe mitral valve regurgitation

Acquired left ventricular pseudoaneurysm is a rare disorder that occurs after acute myocardial infarction. Herein, we present a 55-year-old male patient with a unruptured pseudoaneurysm after acute myocardial infarction presenting with severe mitral regurgitation. After resection of the pseudoaneurysm sac, the defect of 5 cm located at the posterolateral aspect of the left ventricle was repaired with a pericardium patch, and it was determined that mitral regurgitation diminished after cardiac geometry was restored and intervention to the mitral valve not required.

An Infrequent Complication of VT Ablation: Should We Perform Delayed Routine Imaging After Steam Pops?

Catheter ablation has become the cornerstone of the treatment of ventricular arrythmias. Nevertheless, it is crucial to recognize the adverse effects of such treatment. We present a case of an incidental diagnosis of ventricular pseudoaneurysms after catheter ablation for treatment of drug-refractory nonsustained runs of ventricular tachycardia. (Level of Difficulty: Advanced.)

Apical left ventricular pseudoaneurysm: Diagnosis by multimodal cardiac imaging.

Apical left ventricular pseudoaneurysm: Diagnosis by multimodal cardiac imaging.

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.

Recurrent Left Ventricular Apical Pseudoaneurysm at the Site of Previous Patch Repair; a Case Report

: Our case was a 70-year-old male with a past history of coronary artery bypass graft surgery and true aneurysmectomy seven years ago who presented with chest pain and dyspnea. Echocardiography demonstrated scarred and aneurysmal apex (6.15 cm × 2.19 cm) with a small rupture just at most protruding part of it, to and from flow across this rupture site resulted in slow oozing of blood into pericardial sac with mobile clot in apex, clot formation in pericardial sac extended into both apical parts and distorted apical and apicoseptal geometry without communication with right ventricular cavity. Cardiac MRI (CMR) showed the following data: large apical pseudoaneurysm at the site of ruptured patch (depth: 46 mm, width: 60 mm), narrow orifice (5 mm), septated left ventricular apical outpouching surrounded by apical layers and included clots in different sizes and ages. He underwent a successful surgical operation. In this case, CMR provides excellent images essential for patient management.

Left ventricular pseudoaneurysm repair utilizing P2 segment of mitral valve: a case report

BackgroundLeft ventricular (LV) pseudoaneurysms are a rare occurrence typically seen after myocardial infarction (MI) or in patients with prior cardiac surgery and are associated with a significant risk of rupture and mortality. Management includes primary repair, epicardial patching, or percutaneous repair with occlusive devices.Case presentationThis case report describes a 46-year-old male with a large LV pseudoaneurysm that was surgically patched with a segment of his mitral valve. To our knowledge, there has not been a documented repair utilizing a segment of the mitral valve.ConclusionsThe applicability of this technique is limited to cases with posteriorly located pseudoaneurysms near the mitral valve, thus allowing the P2 segment to be used as a patch. This is a novel approach to LV pseudoaneurysm repair, though careful consideration towards patient selection is warranted, as comorbid conditions may contribute to morbidity and mortality.

Systematic review and meta-analysis of the mechanical complications of ischemic heart disease: papillary muscle rupture, left ventricle rupture and post-infarct ventricular septal defect.

Improvements in revascularisation, including pharmacological, catheter-based and surgical, have resulted in improved outcomes for patients with acute myocardial infarction (AMI), leading to decreased frequency of mechanical complications. Improvements in both techniques and technology have permitted select patients to be managed with a purely percutaneous, transcatheter strategy. Through systematic review, this study aims to synthesise the collective experience of percutaneous treatment of the mechanical complications of ischaemic heart disease. The search strategy queried the electronic databases PubMed, Embase and the Cochrane Central Register of Controlled Trials, from 1 January 2000 to 31 December 2020. Studies highlighting the outcomes of patients receiving percutaneous treatment of post-myocardial infarction papillary muscle rupture (PMR), ventricular septal defect (VSD), left ventricular free wall rupture (FWR) and pseudoaneurysm (PA) were included. A qualitative review of studies was conducted for PMR, FWR and PA. A quantitative analysis was conducted for VSD. Fifteen studies were included in the qualitative synthesis of the percutaneous management of PMR, 4 were included in the qualitative analysis of the percutaneous management of left ventricular FWR, 7 studies defined the outcomes of the percutaneous management of PA and 25 were included in the quantitative meta-analysis of the primary percutaneous management of post-MI VSD. For VSD, there were 43 failed procedures in 314 patients. The proportion of failed procedures was 15.9% and there were 174 deaths in 428 patients. 37.5% of patients experienced early mortality. Although surgical techniques remain the gold standard, we have shown that percutaneous management may be a viable option in certain cases.

Left ventricular pseudoaneurysm: the niche of post-infarction mechanical complications

Left ventricular pseudoaneurysm: the niche of post-infarction mechanical complications

Left ventricular pseudoaneurysm: the niche of post-infarction mechanical complications.

Left ventricular pseudoaneurysm (LVP) is a very rare, but potentially lethal mechanical complication of acute myocardial infarction (AMI). Despite representing a unique subset of cardiac rupture, it presents peculiar features that distinguish it from both ventricular free-wall rupture (FWR) and ventricular true aneurysm. LVP occurs in less than 0.5% of patients affected by AMI. However, LVP is generally burdened by high mortality, often related to false cavity rupture, leading to catastrophic and often irreversible consequences. The risk of rupture is inversely proportional to the timing from AMI onset, which also determines both the classification of LVP and drives the indication for treatment. Despite the lack of a current consensus on LVP management, urgent surgery is the treatment of choice for LVPs occurring within 3 months from AMI, especially if larger than 3 cm in diameter. A matter of debate, however, is represented by chronic LVPs, especially because the risk of rupture decreases progressively as time passes and left ventricular (LV) false cavity stabilizes. Surgical mortality rate remains not negligible (more than 20%), but these suboptimal results may be considered acceptable, especially considering the lethality associated with the occurrence of pseudoaneurysm rupture. Diagnostic workup is essential for anatomical characterization of LV rupture, which is mandatory to guide the decision on surgical approach and technique for pseudoaneurysm repair. Finally, for a subset of patients with anterior LVP and a well-defined fibrotic neck, and deemed at excessively high surgical risk, percutaneous closure of the cavity has been described with encouraging results.