Left ventricular pseudoaneurysm

Abstract

Left ventricular (LV) pseudoaneurysms form when cardiac rupture is contained by adherent pericardium or scar tissue. Although LV pseudoaneurysms are not common, the diagnosis is difficult and they are prone to rupture. We evaluated the clinical presentation, diagnostic accuracy of imaging modalities, results of therapy and prognosis of 290 patients with LV pseudoaneurysms. Most cases of LV pseudoaneurysm were related to myocardial infarction (particularly inferior wall myocardial infarction) and cardiac surgery. Congestive heart failure, chest pain and dyspnea were the most frequently reported symptoms, but >10% of patients were asymptomatic. Physical examination revealed a murmur in 70% of patients. Almost all patients had electrocardiographic abnormalities, but these were usually nonspecific ST segment changes; only 20% of patients had ST segment elevation. Although radiographic findings were also usually nonspecific, the appearance of a mass was present in more than one half of patients and may be an important clue to the correct diagnosis. Left ventricular angiography was the most definitive test and can be useful in planning surgery since concomitant coronary angiography can be performed. Regardless of treatment, patients with LV pseudoaneurysms had a high mortality rate, especially those who did not undergo surgery. Because the symptoms, signs, electrocardiographic abnormalities and radiographic findings seen in patients with LV pseudoaneurysms can be indistinguishable from those in patients with coronary disease alone, a high clinical index of suspicion is needed to avoid missing the diagnosis.

Triple rule-out CT in the emergency department: protocols and spectrum of imaging findings

“…7). In contrast to ventricular wall rupture, a pseudoaneurysm is a contained rupture of the myocardium that can be seen after infarction, surgery, trauma, infection, or invasive medical procedures [59] (Fig. 8).…”

Minimally Invasive Treatment of a Left-Ventricular Aneurysm Via a Left- Thoracic Thoracotomy as Re-Do

“…The surgical risk of repair is barely known, due to the small number of series published. Left ventricular pseudo-aneurysms usually present with symptoms, but about 10% of patients are asymptomatic [4]. This 82-yearold patient was diagnosed with an apical left ventricular aneurysm in a routine post-operative control during rehabilitation.…”

“…The danger of secondary rupture is real for large pseudoaneurysms, but under discussion for smaller ones. Untreated pseudoaneurysms have an approximately 30% to 45% risk of rupture [4]. The surgical risk of repair is barely known, due to the small number of series published.…”

Incidental Left Ventricular Pseudoaneurysm Discovered 5 Years after Myocardial Infarction

“…LV pseudoaneurysm is most commonly the result of a transmural acute MI when myocardial rupture is contained by pericardial adhesions or scar tissue. Diagnosis can be complicated because patients usually present with symptoms similar to coronary artery disease [1]. CT accurately delineates the extent of a LV pseudoaneurysm and allows for assessment of both intra-cardiac and extra-cardiac anatomy.…”