Distinguishing Left Ventricular Aneurysm From Pseudoaneurysm

Brown, Steven L.; Gropler, Robert J.; Harris, Kevin M.

doi:10.1378/chest.111.5.1403

Cited by 159 publications

(143 citation statements)

References 36 publications

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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%

“…12 Chest roentgenography often reveals a pseudoaneurysm as a discrete protrusion in the cardiac shadow. 2 Echocardiography and Doppler color flow images are useful noninvasive modalities for diagnosing pseudoaneurysms, which produce a bounded echo-free space with the orifice of a narrow neck communicating with the left ventricle, the maximal diameter of the orifice being smaller than the maximal aneurysmal diameter (Omax/Dmax <0.5) and abnormal bidirectional blood flow occurring across the orifice.…”

Section: Discussionmentioning

confidence: 99%

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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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Section: Discussionmentioning

confidence: 99%

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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“…Os grandes aneurismas, em geral, sucedem os infartos transmurais e, em cerca de 75% dos casos, mostram trombose da luz 16 . Ao contrário dos chamados pseudo-aneurismas, onde existe um grande risco de ruptura, nos aneurismas ventriculares verdadeiros, a urgência da correção cirúrgica não é tão grande 17 . Além disso, a presença do aneurisma, isoladamente, não é considerada como um fator preditivo de óbito, se descontados a gravidade da IC e a idade 17 .…”

Section: Comentáriosunclassified

“…Ao contrário dos chamados pseudo-aneurismas, onde existe um grande risco de ruptura, nos aneurismas ventriculares verdadeiros, a urgência da correção cirúrgica não é tão grande 17 . Além disso, a presença do aneurisma, isoladamente, não é considerada como um fator preditivo de óbito, se descontados a gravidade da IC e a idade 17 . Logo, sendo o restante do miocárdio pouco comprometido, a aneurismectomia poderia resultar em restabelecimento da função contrátil do miocárdio.…”

Section: Comentáriosunclassified

Correlação anatomoclínica: Caso 3/98 - Instituto do Coração do Hospital das Clínicas - FMUSP

1998

Arq. Bras. Cardiol.

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“…As in this case, prompt echocardiographic diagnosis is essential [2], as pseudoaneurysms have a high risk of free rupture, leading to hemopericardium and in most cases death from cardiac tamponade. Patients can be salvaged only by emergency surgical repair [3].…”

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confidence: 99%