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 transducer on an iE33 ultrasound machine (Philips, Andover, MA) capable of both multiplane 2D and real-time 3D, which demonstrated the aneurysm within an intact epicardium (Figure 4, Movie II). This was consistent with a subepicardial aneurysm. Although the transthoracic echocardiogram and LV ventriculogram demonstrated the abnormality, the features were not distinct enough to differentiate aneurysm subtypes. However, multiplane 2D tomographic sections and the real-time 3D volumetric imaging precisely demonstrated a subepicardial aneurysm.Both "true aneurysms" and "pseudoaneurysms" are outpouching of the LV beyond the outside contour of the chamber. The former contains all three myocardial layers, and the latter represents a true contained rupture of the myocardium by a blood clot with the adjoining parietal pericardium mostly due to ischemia or trauma. A pseudoaneurysm often needs surgical intervention to prevent a pericardial rupture and possible sudden cardiac death. On the other hand, a subepicardial aneurysm is an interruption of the endocardium and myocardium with an intact epicardium.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
customersupport@researchsolutions.com
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
This site is protected by reCAPTCHA and the Google Privacy Policy and Terms of Service apply.
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.