Left Ventricular Pseudoaneurysm and Left Ventricular Thrombus in a Patient Presenting with an Acute ST-Elevation Myocardial Infarction

Abbood, Ali; Salihi, Hareer Al; Olivier, Maxim; Khawaja, Farhan J.; Madruga, Mario; Carlan, S. J.

doi:10.12659/ajcr.934272

Cited by 3 publications

(2 citation statements)

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“…Detailed study selection process in detail for LVPA and LVA is presented in Supplementary figure 1 and 2, respectively. After removing duplicates and ineligible articles, we included 379 eligible articles on post-MI LVPA (N= 504 patients) (9–392) and 120 on post-MI LVA (n=20,968). (31,97,145,148,152,158,393–472) Supplementary Table 3. shows the quality of the included case series; all studies scored eight or higher.…”

Section: Resultsmentioning

confidence: 99%

Clinical characteristic and imaging findings of post-infarction left ventricular pseudoaneurysm versus aneurysm: a pooled analysis of 21,472 patients

Afshar

Tayebi

Samimisedeh

et al. 2023

Preprint

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Background Left ventricular pseudoaneurysm (LVPA) is a rare but life-threatening complication of myocardial infarction (MI). Given the similarities in the clinical presentations and the appearance of the cardiac imaging, differentiation of LVPA from left ventricular aneurysm (LVA) remains a challenge but is imperative for timely management. We summarized and compared clinical and imaging findings of post-MI LVPA and LVA. Method We performed a comprehensive search of the literature in PubMed and Scopus databases using combinations of key terms covering LVPA / LVA and MI. In both LVA and LVPA, individual-level patient data (IPD) and aggregated-level data (AD) studies were combined through a two-stage analysis method. Results We identified 379 eligible articles on LVPA (N= 504 patients) and 120 on LVA (n= 20,968). Based on our pooled analysis, cases were predominantly male in both groups (70.4%and 75.7 %, respectively), but LVPA patients were roughly older (Mean (95% Confidence interval (CI): (65.4 (62.4, 68.4) vs. 60.8 (58.9, 62.8) years, respectively) and had a shorter mean time interval from MI to diagnosis than LVA (5.1 vs. 27.8, months). At presentation, while 33.8 (95% CI: 22.1, 46.0) of patients with LVA had arrhythmia, only 1.0 % (95% CI: 0.0, 2.9) of LVPA patients presented with this symptom. LVPA compared to the LVA group, more frequently had ST-segment elevation (43.2% Vs. 28.6, respectively) but less frequently ECG signs of the old MI (42.2% Vs. 61.9, respectively). Echocardiography showed a lower diagnostic value in LVPA than LVA (Sensitivity: 81.4% Vs. 97.5%). Contrary to LVA, LVPA is mainly located on posterior and inferior segments based on echocardiography evaluations. On Cardiac MRI, the majority of LVPA patients had pericardial LGE (84.0% (CI 95%: 63.9, 95.5)). A higher percentage of LVPA compared to the LVA group dead during hospitalization (13.8% vs. 4.7%, respectively) or after discharge (17.5%vs. vs. 9.0%, respectively). Conclusion Arrhythmia is likely common in LVA patients at presentation but not in LVPA. LVPA is mainly located on the posterior and inferior, and LVA is on the anterior and apical segments. On cardiac MRI, pericardial LGE may suggest the presence of LVPA rather than LVA in suspected patients.

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Section: Resultsmentioning

confidence: 99%

Clinical characteristic and imaging findings of post-infarction left ventricular pseudoaneurysm versus aneurysm: a pooled analysis of 21,472 patients

Afshar

Tayebi

Samimisedeh

et al. 2023

Preprint

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“…Due to its high risk of catastrophic rupture, urgent surgical intervention is crucial in the treatment of this condition. 12 A dangerous complication of mitral valve replacement is rupture of the left ventricular posterior wall (MVR). Depending on when it is presented, it is typically divided into three categories: early, delayed, or late.…”

Section: Discussionmentioning

confidence: 99%

Left Ventricular Thrombosed Pseudoaneurysm as a Delayed Complication of Myxoma Resection and Mitral Valve Replacement: A Unique Case Report

Hassan¹,

Öcal²,

Waberi³

et al. 2023

RRCC

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A pseudoaneurysm of the left ventricle (LV) is a partial cardiac rupture surrounded by a pericardium that retains a connection with the LV lumen. Case Presentation:We present here a 30-year-old patient who came to our clinic for a routine check-up with no symptoms or complaints. After performing echocardiography, the patient's echocardiography demonstrated a left ventricular pseudo-aneurysm which had collected a massive amount of thrombus. Three years earlier, the patient had a left atrial myxoma excision with mechanical mitral valve replacement following a presentation with shortness of breath. Clinical discussion: Left ventricular pseudo-aneurysm is a hazardous complication of mostly myocardial infraction and certain cardiac procedures, such as mitral valve replacement, where it may lead to thrombus formation. Due to this condition's serious risk of lethal rupture and embolization from thrombus formation, as in our case, immediate surgical intervention is essential for its treatment. Conclusion: Left ventricular pseudo-aneurysm is an abnormal finding post-cardiac surgery, and it should be considered during patient evaluation after the surgery immediately and later in life.

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A New Nomogram Prediction Model for Left Ventricular Thrombus in Patients with Left Ventricular Aneurysm after Acute Myocardial Infarction

Xu,

Zhang,

et al. 2024

Rev. Cardiovasc. Med.

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Background: To identify the factors influencing the development of a left ventricular thrombus (LVT) in patients with a left ventricular aneurysm (LVA) after acute myocardial infarction (AMI) and to utilize these variables to establish a new nomogram prediction model for individual assessment in LVT. Methods: We screened data on 1268 cases of LVA at the China-Japan Union Hospital of Jilin University between January 1, 2018 and December 31, 2023, and identified a total of 163 LVAs after AMI. The independent risk factors of LVT in patients with LVA after AMI were identified from univariable and multivariable logistic regression analyses and a nomogram prediction model of LVT was established with independent risk factors as predictors. We used the area under the curve (AUC) and a calibration curve to determine the predictive accuracy and discriminability of nomograms. Furthermore, decision curve analysis (DCA) was utilized to further validate the clinical effectiveness of the nomogram. Results: Multivariate logistic regression analysis identified that preoperative thrombus in myocardial infarction 0, left ventricular diameter, and anterior wall myocardial infarction were independent risk factors of LVT in patients with LVA after AMI (p < 0.05). The nomogram prediction model constructed using these variables demonstrates exceptional performance, as evidenced by well-calibrated plots, favorable results from DCA, and the AUC of receiver operating characteristic (ROC) analysis was 0.792 (95% CI: 0.710–0.874, p < 0.01). Conclusions: A new nomogram prediction model was developed to enable precise estimation of the probability of LVT in patients with LVA after AMI, thereby facilitating personalized clinical decision-making for future practice.

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Left Ventricular Pseudoaneurysm and Left Ventricular Thrombus in a Patient Presenting with an Acute ST-Elevation Myocardial Infarction

Cited by 3 publications

References 0 publications

Clinical characteristic and imaging findings of post-infarction left ventricular pseudoaneurysm versus aneurysm: a pooled analysis of 21,472 patients

Clinical characteristic and imaging findings of post-infarction left ventricular pseudoaneurysm versus aneurysm: a pooled analysis of 21,472 patients

Left Ventricular Thrombosed Pseudoaneurysm as a Delayed Complication of Myxoma Resection and Mitral Valve Replacement: A Unique Case Report

A New Nomogram Prediction Model for Left Ventricular Thrombus in Patients with Left Ventricular Aneurysm after Acute Myocardial Infarction

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