Anévrysme ventriculaire gauche et communication interventriculaire compliquant un infarctus du myocarde

Abstract

L'association d'une communication interventriculaire post infarctus du myocarde et d'un anévrysme du ventricule gauche chez un même patient est extrêmement rare et survient habituellement durant la première semaine qui suit un infarctus du myocarde. Nous rapportons le cas insolite d'un patient âgé de 63 ans, admis pour choc cardiogénique en rapport avec une communication inter ventriculaire apicale et un anévrysme ventriculaire gauche causés par un infarctus du myocarde antérieur. La correction chirurgicale a consisté en une fermeture du défect septal par un patch en dacron via une ventriculotomie gauche associée à une anévrysectomie et un mono pontage coronaire. Cette observation illustre d'une part la rareté de l'association communication inter ventriculaire-anévrysme ventriculaire gauche post infarctus du myocarde, et d'autre part l'efficacité du traitement chirurgical qui reste la seule option salvatrice pour cette pathologie.

Myocardial Infarction Seen Tardively Complicated by Ventricular Septal Rupture Extending to the Right Ventricule: A Dilemmatic Scenario

“…The incidence of VSR secondary to MI is lower (0.2%) as stipulated in the GUSTO-I studys of the benefit of early thrombolysis in acute MI [10]. VSRs can appear within a few hours to one week after necrosis, with a majority between the second and fourth day [9,11]. This period is, however, ten days in our patient due negligence of symptoms.…”

“…It is a rare complication still associated with a high mortality rate [1]. The impact of this complication has been estimated between 1% and 2% of MIs, but it is responsible for 5% of deaths in the acute phase of Myocardial infarction [9]. The incidence of VSR secondary to MI is lower (0.2%) as stipulated in the GUSTO-I studys of the benefit of early thrombolysis in acute MI [10].…”

“…Transthoracic echocardiography (TTE) is the choice in the diagnosis and evaluation of VSR complicating a myocardial infarction with a very high sensitivity and specificity [9,13]. The TTE will make it possible to objectify the VSR, to locate it, to measure its size, to observe the direction of the shunt, to calculate the shunt, to estimate the systolic pressures functions of the left ventricle and that of systolic function of the right ventricle.…”

Radiological and hemodynamic parameters in patients with suspected ventricular aneurysm and interventricular septal perforation after acute myocardial infarction: A comparison of non‑invasive and invasive diagnostic modalities

“…A true or pseudo ventricular aneurysm is the worst complication of transmural myocardial infarction ( 1 ). Left ventricular aneurysm after myocardial infarction is rare and usually occurs during the first week following the cardiac event but certain patients may present after a significant time following the cardiac event(s) ( 2 ). Interventricular septal perforation is also an infrequent but severe problem following myocardial infarction ( 3 ).…”