Current concepts of left ventricular pseudoaneurysm: Pathophysiology, therapy, and diagnostic imaging methods

March, Keith L.; Sawada, Stephen; Tarver, Robert D.; Kesler, Kenneth A.; Armstrong, William F.

doi:10.1002/clc.4960120911

Cited by 52 publications

(51 citation statements)

References 51 publications

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“…Common chest roentgenographic findings include the appearance of a mass, found in more than 50% of patients, or an enlarged cardiac silhouette with a distinct posterior/lateral bulge (1,6,9,10). True aneurysms, on the contrary, will display a generalized enlargement of the cardiac silhouette (11). Although electrocardiography may reveal ST-segment elevation in 20% of patients, most EKGs show nonspecific ST-segment changes (1,6).…”

Section: Discussionmentioning

confidence: 99%

Left ventricular pseudoaneurysm causing myocardial infarction and cerebrovascular accident

Hoey¹,

Kravitz²,

Vanderbeek³

et al. 2005

The Journal of Emergency Medicine

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Section: Discussionmentioning

confidence: 99%

Left ventricular pseudoaneurysm causing myocardial infarction and cerebrovascular accident

Hoey¹,

Kravitz²,

Vanderbeek³

et al. 2005

The Journal of Emergency Medicine

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“…If the development of a spreading intramural hematoma, which dissects into the myocardial wall, is stopped, then a so-called pseudo-false aneurysm, a diverticulum of the left ventricle or a subepicardial aneurysm, will develop. [1][2][3][4][5][6][8][9][10][11][12] The constellation of features of a subendocardial aneurysm consists of an abrupt interruption of the myocardium, a narrow neck and a propensity to rupture spontaneously regardless of its wall's components. 4 When transthoracic 2-dimensional echocardiography was performed for the first time in the present patient, all the criteria for a completed subepicardial aneurysm and inferior MI with a subepicardial aneurysm of the left ventricle were observed.…”

Section: Discussionmentioning

confidence: 99%

Pseudoaneurysm of the Left Ventricle Progressing From a Subepicardial Aneurysm

Koito¹,

Nakamura²,

Suzuki³

et al. 1999

Jpn Circ J

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pseudoaneurysm of the left ventricle is a rare complication of a myocardial infarction (MI), cardiac surgery, trauma, infection or inflammation, and like a true aneurysm of the left ventricle after MI it may cause left ventricular failure, embolization or ventricular arrhythmia. 1,2 In contrast to a true aneurysm, in which a left ventricular rupture may occur early in the clinical course but is extremely rare in the late phase, a pseudoaneurysm has a propensity to rupture and cause sudden death even in the chronic stage and when it is small. 3 As a result, early diagnosis and surgical exploration of a left ventricular pseudoaneurysm is vital. The features of a subepicardial aneurysm of the left ventricle consist of an abrupt interruption of the myocardium, a narrow neck and a propensity to rupture spontaneously, regardless of its wall's components. [4][5][6] We describe a patient with a huge left ventricular pseudoaneurysm that had progressed from a small subepicardial aneurysm. Case ReportA 56-year-old man had been admitted 6 months previously to the hepatology department of Kansai Medical University Hospital due to an acute hepatitis caused by type B hepatitis virus. The presence of pericardial effusion was suspected based on the abdominal ultrasonography Japanese Circulation Journal Vol.63, July 1999 performed just before his discharge, and echocardiography incidentally revealed an inferior wall MI with a subepicardial aneurysm of the left ventricle (Fig 1a, b). As he had no cardiac symptoms he refused any further examinations or consultations regarding this abnormality and was discharged from the hospital to continue his work as a construction worker there. One month before the current presentation he caught a cold, and although his body temperature recovered to the normal range, both coughing and dyspnea continued and so he re-presented at hospital. The patient's heart rate was 80 beats/min with a regular rhythm. Blood pressure was 118/80 mmHg. The third heart sound was heard at the apex, but no heart murmur was present on auscultation. Laboratory studies were normal. Chest roentgenography revealed a cardiothoracic ratio of 52%, slight pulmonary congestion and an abnormal protrusion at the lower left margin of the cardiac shadow (Fig 2). An electrocardiogram showed a normal sinus rhythm, a left atrial abnormality, Q waves and inverted T waves in leads II, III and aVF (Fig 3). Two-dimensional echocardiography disclosed a huge echo-free space behind the inferior myocardial wall and an abnormal cavity that communicated with the left ventricle through a small hole at the inferior myocardial wall (Fig 1c, d). The blood flows across the hole from the left ventricle to the cavity in systole and from the cavity to the left ventricle in diastole were observed by Doppler color flow imaging (Fig 4). These findings were compatible with a pseudoaneurysm of the left ventricle. Thallium-201 myocardial scintigraphy showed a complete defect of the inferoposterior wall. On radionuclide angiocardiography, a huge abnormal cavi...

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“…Síncope, complicações tromboembólicas, arritmias ventriculares e endocardite são extremamente raras 8 . Em relação à topografia, os pseudoaneurismas, usualmente, são encontrados na parede inferior, posterior ou lateral, em contraste com os aneurismas verdadeiros que têm distribuição tipicamente ântero-apical 9,10 . Pseudoaneurismas de parede posterior são 3,5 vezes mais comuns do que de parede anterior.…”

Section: Discussionunclassified

Ressonância nuclear magnética no diagnóstico de pseudoaneurisma de ventrículo esquerdo. Antigo problema, nova opção

Alvarenga¹,

Kopel²,

Dallan³

et al. 1997

Arq. Bras. Cardiol.

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Relato de CasoPseudoaneurisma de ventrículo esquerdo (VE) é o resultado de uma rotura do miocárdio, na qual o hematoma resultante está contido em uma área circunscrita pelo pericárdio. Assim, os pseudoaneurismas têm sua parede formada por pericárdio e tecidos extracardíacos, enquanto nos aneurismas verdadeiros a parede é formada por miocárdio necrosado e tecido fibroso. Os pseudoaneurismas formam uma cavidade conectada ao VE por um colo estreito e podem apresentar trombose em seu interior. As causas mais freqüentemente associadas à formação de pseudoaneurisma de VE são infarto agudo do miocárdio (IAM), complicações de procedimentos cirúrgicos, trauma torácico ou endocardite bacteriana 1,2 . Apesar das manifestações clínicas dos pseudoaneurismas serem inespecíficas, o diagnóstico preciso é importante para o tratamento adequado, sendo que o uso de mé-todos por imagem desempenha um papel fundamental 3 . O diagnóstico precoce e a correção cirúrgica são importantes para a diminuição da mortalidade e a correção cirúrgica deve ser feita independente da presença de sintomas ou da necessidade de revascularização do miocárdio concomitante 4,5 . Apresentamos o caso de um portador de pseudoaneurisma de VE pós-IAM da parede lateral, em que métodos de imagem não-invasivos, isto é, ecocardiograma transesofágico e ressonância nuclear magnética foram decisivos para o diagnóstico. Dois meses após o infarto, o paciente foi submetido à correção cirúrgica com sucesso. Relato do CasoMulher de 61 anos, com antecedente de infarto do miocárdio ínfero-látero-dorsal em agosto/95 e submetida a desobstrução mecânica e angioplastia transluminal coronária da artéria circunflexa na fase aguda do infarto.Em 23/3/96, deu entrada no serviço de emergência com IAM em edema agudo do pulmão. Na evolução apresentou choque cardiogênico, taquicardia ventricular, bloqueio atrioventricular total intermitente, bloqueio de ramo direito e bloqueio divisional ântero-superior do ramo esquerdo, sendo necessário implante de marcapasso provisório.Indicado cateterismo cardíaco com cineangiocoronariografia de urgência que revelou: artéria circunflexa ocluída, artéria descendente anterior com 70% de obstru-

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Current concepts of left ventricular pseudoaneurysm: Pathophysiology, therapy, and diagnostic imaging methods

Cited by 52 publications

References 51 publications

Left ventricular pseudoaneurysm causing myocardial infarction and cerebrovascular accident

Left ventricular pseudoaneurysm causing myocardial infarction and cerebrovascular accident

Pseudoaneurysm of the Left Ventricle Progressing From a Subepicardial Aneurysm

Ressonância nuclear magnética no diagnóstico de pseudoaneurisma de ventrículo esquerdo. Antigo problema, nova opção

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