Left ventricle pseudoaneurysm: Diagnosis by a new murmur

Abstract

Left ventricular free wall rupture is invariably a calamitous event with the most frequent presentation being sudden hemodynamic collapse and death [1]. In such a scenario, however, a pseudoaneurysm may be considered a blessing in disguise. Left ventricular pseudoaneurysm (LVPA) develops when the rupture is contained by adherent pericardium, overlying fibrin and clot, or scar tissue. This prevents the rapid accumulation of blood in the pericardial space which would have otherwise led to death via the formation of a fatal pericardial tamponade. In contrast to rupture per se, one with a false aneurysm can lead to longer survival, thus providing physicians with crucial hours, days, or rarely even weeks to make the diagnosis [2]. LVPA is clinically uncommon and remains a challenge to diagnose. It can have numerous presentations, ranging from asymptomatic to chest pain and dyspnea [3]. Hence, it merits a high index of suspicion. The importance of making the diagnosis cannot be overstated, since the incidence of a fatal left ventricular rupture from a pseudoaneurysm varies from 19 to 32% [4]. We present a case in which an asymptomatic LVPA was diagnosed by picking up a new murmur on physical examination. Case report A 70-year-old male of Vietnamese origin was referred to the emergency room from an urgent care set up because of chest pain,

Left ventricular free wall rupture caused by myocardial ischemia without treatable atherosclerotic coronary disease: a case series

“…Whereas right ventricular free wall rupture caused by acute right coronary artery disease may resolve with moderate less-invasive treatment [3]. Conservative treatment of LVFWR [4] has as direct consequence the late development of pseudoaneurysm, impairing left ventricular pump function [5][6][7]12] more often than the right ventricular rupture [13]. Moreover, studies show that the surgical repair of LVFWR by means of glue application and local compression off-pump [14], might not be as effective on long term as the direct suture on CPB or the resection of the necrotic area with patch replacement on cardiac arrest [15].…”