Left ventricular pseudoaneurysm after myocardial infarction

Abstract

In this report, a case of a left ventricular (LV) pseudoaneurysm due to a previous myocardial infarction, which was repaired successfully, is described. A 62-year-old man, with a history of acute anterior wall myocardial infarction 6 months previously, was admitted with the complaints of acute dyspnea and palpitation. Echocardiography revealed an LV aneurysm, and ventriculography showed ventricular dysfunction and an LV pseudoaneurysm. Coronary angiography showed total occlusion of the proximal segment of the left anterior descending artery with a very thin lumen and insufficient retrograde filling. Under cardiopulmonary bypass and beating heart, the pseudoaneurysm was resected and the defect on the ventricular free wall was closed by the remodeling ventriculoplasty method of Dor. Histopathologic examination of the resected material confirmed the diagnosis of pseudoaneurysm. The postoperative course of our patient was uneventful. He was discharged on the ninth postoperative day.

A large pseudoaneurysm of the left cardiac ventricle in a 57-year-old patient after urgent coronary artery bypass grafting and surgical mitral valve replacement due to acute myocardial infarction

“…It develops as a result of myocardial free wall rupture, and its external boundary is constituted by the pericardium. Pseudoaneurysms, even if small and asymptomatic, tend to rapidly expand their dimensions, which increases the risk of their rupture and consequent life-threatening tamponade [1, 2]. Late myocardial rupture, as in the described case, occurs within days or years after the myocardial infarction or the cardiac surgery procedure and results in the development of a false aneurysm; if the lesion does not cause any symptoms, it may go unnoticed and therefore remain untreated [3].…”

“…It is postulated that inferior wall infarctions are the most common risk factor for left ventricular pseudoaneurysm development, predisposing to this lesion twice more frequently than anterior wall infarctions [6]. False aneurysms are most often located on the anterior, inferior, or lateral wall or on the apex of the heart [1, 6], which stems from the protective action of the pericardial sac and the restricted possibility of aneurysm expansion in these locations. Due to the overlap of several factors, the described patient was burdened with a relatively high risk of pseudoaneurysm development.…”

“…Notwithstanding, it is estimated that over 10-12% of patients may remain asymptomatic [1, 6, 7]. The situation is similar as regards objective signs.…”

“…Cases of embolism with thrombotic material originating from the lumen of the false aneurysm have been described [1, 3]. Another factor predisposing the studied patient to embolism was paroxysmal atrial fibrillation.…”

Unruptured left ventricular pseudoaneurysm following inferior wall myocardial infarction

“…The diagnosis of pseudoaneurysm is usually suggested by imaging modalities such as transthoracic/transesophageal echocardiography, LV angiography, magnetic resonance imaging (MRI), CT and radionuclide scanning [9].…”