Left Ventricular Pseudoaneurysm
2019; Lippincott Williams & Wilkins; Volume: 12; Issue: 12 Linguagem: Francês
10.1161/circimaging.119.009500
ISSN1942-0080
AutoresAlexandre Caldeira, Diogo Albuquerque, Marta Coelho, Hugo Côrte-Real,
Tópico(s)Mechanical Circulatory Support Devices
ResumoHomeCirculation: Cardiovascular ImagingVol. 12, No. 12Left Ventricular Pseudoaneurysm Free AccessCase ReportPDF/EPUBAboutView PDFView EPUBSections ToolsAdd to favoritesDownload citationsTrack citationsPermissionsDownload Articles + Supplements ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toSupplemental MaterialFree AccessCase ReportPDF/EPUBLeft Ventricular PseudoaneurysmImagiologic and Intraoperative Images Alexandre Caldeira, MD, Diogo Albuquerque, MD, Marta Coelho, MD and Hugo Côrte-Real, MD Alexandre CaldeiraAlexandre Caldeira Alexandre B. Caldeira, MD, Department of Anaesthesiology, Centro Hospitalar Universitário Lisboa Norte, Hospital de Santa Maria, Avenida Professor Egaz Moniz, 1649-035 Lisboa, Portugal. Email E-mail Address: [email protected] Department of Anaesthesiology (A.C., D.A., M.C.), Centro Hospital Universitário Lisboa Norte, Hospital de Santa Maria, Lisboa, Portugal. , Diogo AlbuquerqueDiogo Albuquerque Department of Anaesthesiology (A.C., D.A., M.C.), Centro Hospital Universitário Lisboa Norte, Hospital de Santa Maria, Lisboa, Portugal. , Marta CoelhoMarta Coelho Department of Anaesthesiology (A.C., D.A., M.C.), Centro Hospital Universitário Lisboa Norte, Hospital de Santa Maria, Lisboa, Portugal. and Hugo Côrte-RealHugo Côrte-Real Department of Intensive Care Medicine (H.C.-R.), Centro Hospital Universitário Lisboa Norte, Hospital de Santa Maria, Lisboa, Portugal. Originally published26 Nov 2019https://doi.org/10.1161/CIRCIMAGING.119.009500Circulation: Cardiovascular Imaging. 2019;12:e009500A 55-year-old woman with a history of an anterior and inferior myocardial infarction with ST elevation 1 month earlier was transferred to our institution with chest pain and syncope. On physical examination, her heart rate was 113 bpm, her arterial blood pressure was 95/71 mm Hg, and peripheral oxygen saturation was 89% while breathing ambiente air. The ECG showed sinus tachycardia and chest X-ray revealed an enlarged heart. She performed a coronary angiography that showed an occlusion of the left anterior descending artery and was treated by angioplasty. Her left ventricular ejection fraction was estimated to be 30% on echocardiographic examination. Two-dimensional transthoracic echocardiography showed an apical left ventricular (LV) discontinuity, suggestive of a pseudoaneurysm or aneurysm (Figure A, arrows). A minimal pericardial effusion was present. Doppler showed flow passage from the left ventricle into an echo-free space. Cardiac magnetic resonance imaging was subsequently performed and this confirmed the presence of a pseudoaneurysm of the apical segment of LV (Figure [B and C], arrows; Movie I in the Data Supplement), and pericardial effusion.The patient underwent surgery, which showed a large pseudoaneurysm (Figure [D], arrows). The intraoperative transoesophageal echocardiography showed the pseudoaneurysm (Movie II in the Data Supplement) with confirmation of flow between left ventricle and the pseudoaneurysm (Figure [E], arrow). The large LV pseudoaneurysm was repaired with a pericardial patch with good postoperative control echocardiogram (Figure [F]; Movie III in the Data Supplement). Her condition improved after surgery and she was discharged from hospital on postoperative day 10.DiscussionLeft ventricular aneurysm and pseudoaneurysm are 2 complications of myocardial infarction in which the role of imaging is paramount. Pseudoaneurysms are a result of rupture of the ventricular free wall, contained by overlying adherent pericardium, while true aneurysm are defined as areas of thinned myocardium which are dyskinetic and involve the full thickness of the Wall.1 They typically have a neck narrower than the diameter of the aneurysm and are more often located in the posterior and lateral wall segments.2 More importantly, pseudoaneurysms have a higher risk of rupture (30%–45%) and death.1,2 It is a rare complication that is reported in <0.1% of all patients with myocardial infarction and usually present within 2 months.1 The diagnosis can be difficult, as patients often are either asymptomatic, or present with nonspecific symptoms attributable to other causes.Differentiation between LV pseudoaneurysms and true aneurysms can be challenging and investigations include transthoracic echocardiography/transoesophageal echocardiography, LV angiography, magnetic resonance imaging, computed tomography, radionuclide scanning. One way of assessing this on echocardiography is by comparing the diameter of the orifice/neck of the aneurysm with its maximum diameter.2 The presence of turbulent flow by pulsed Doppler at the neck of a cavity or within the cavity itself also suggests presence of a pseudoaneurysm.3 Magnetic resonance imaging is useful for differentiating and allows visualization of the entire heart and is able to clearly distinguish between structures such as pericardium, myocardium thrombus, and epicardial fat.The surgery is recommended as the treatment of choice, as the risk of fatal rupture is felt to outweigh the risk of surgery.4This case report is interesting because the pseudoaneurysm did not have a typical echocardiographic apperance. Magnetic resonance imaging scanning was necessary to establish the diagnosis, presumably from a contained rupture that had occured as a result of her myocardial infarct.Download figureDownload PowerPointFigure. Left ventricular pseudoaneurysm.A, Apical 4-chamber view of of transthoracic echocardiography. B, Cardiac magnetic resonance imaging coronal view. C, Cardiac magnetic resonance imaging axial view. D, Intraoperative image. E, Two-chamber mid-esophageal view of transesophageal echocardiography with flow. F, Apical 4-chamber view of transthoracic echocardiography after repair.DisclosuresNone.FootnotesThe Data Supplement is available at https://www.ahajournals.org/doi/suppl/10.1161/CIRCIMAGING.119.009500.Alexandre B. Caldeira, MD, Department of Anaesthesiology, Centro Hospitalar Universitário Lisboa Norte, Hospital de Santa Maria, Avenida Professor Egaz Moniz, 1649-035 Lisboa, Portugal. Email [email protected]comReferences1. Alapati L, Chitwood WR, Cahill J, Mehra S, Movahed A. Left ventricular pseudoaneurysm: a case report and review of the literature.World J Clin Cases. 2014; 2:90–93. doi: 10.12998/wjcc.v2.i4.90CrossrefMedlineGoogle Scholar2. Tuan J, Kaivani F, Fewins H. Left ventricular pseudoaneurysm.Eur J Echocardiogr. 2008; 9:107–109. doi: 10.1016/j.euje.2007.03.043MedlineGoogle Scholar3. Loperfido F, Pennestrì F, Mazzari M, Biasucci LM, Vigna C, Laurenzi F, Manzoli U. Diagnosis of left ventricular pseudoaneurysm by pulsed Doppler echocardiography.Am Heart J. 1985; 110:1291–1293. doi: 10.1016/0002-8703(85)90026-2CrossrefMedlineGoogle Scholar4. Prêtre R, Linka A, Jenni R, Turina MI. Surgical treatment of acquired left ventricular pseudoaneurysms.Ann Thorac Surg. 2000; 70:553–557. doi: 10.1016/s0003-4975(00)01412-0CrossrefMedlineGoogle Scholar Previous Back to top Next FiguresReferencesRelatedDetailsCited By Ansari A, Rawat D and Ahmed A (2021) Left ventricular pseudoaneurysm post primary angioplasty, Coronary Artery Disease, 10.1097/MCA.0000000000001114, 33:4, (337-338), Online publication date: 1-Jun-2022. Jallal H, Belabes S and Khatouri A (2022) Uncommon post-infarction pseudoaneurysms: A case report, World Journal of Cardiology, 10.4330/wjc.v14.i4.260, 14:4, (260-265), Online publication date: 26-Apr-2022. Banisauskaite A, Velavan P, Hasleton J, Mediratta N, Arzanauskaite M, Binukrishnan S, Potter T, Henzel J, Karamisis G, Bernstein B and Sunjaya A (2021) Myocardial rupture and left ventricular pseudoaneurysm due to late STEMI presentation during the COVID-19 pandemic lockdown: a classical case report, European Heart Journal - Case Reports, 10.1093/ehjcr/ytab253, 5:7, Online publication date: 1-Jul-2021. December 2019Vol 12, Issue 12 Advertisement Article InformationMetrics © 2019 American Heart Association, Inc.https://doi.org/10.1161/CIRCIMAGING.119.009500PMID: 31766861 Originally publishedNovember 26, 2019 Keywordsheart ratechest painechocardiographypericardial effusioncoronary angiographyPDF download Advertisement SubjectsCardiovascular SurgeryEchocardiographyMagnetic Resonance Imaging (MRI)Myocardial Infarction
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