Pseudoaneurisma ventricular esquerdo – um desafio diagnóstico

Abstract

Left ventricular pseudoaneurysm is a rare complication of acute myocardial infarction, associated with high mortality. However, it can present in a non-specific manner, complicating and delaying the diagnosis. The authors present the case of a 65-year-old patient, hypertensive, with no other known relevant medical history, who presented with chest pain, cough and left pleural effusion, initially attributed to a pulmonary process. However, these were in fact the result of a left ventricular pseudoaneurysm following silent acute myocardial infarction. The diagnosis was suspected on echocardiography and confirmed by cardiac magnetic resonance imaging, and the patient underwent successful surgical pseudoaneurysm repair. This case illustrates an atypical presentation of a left ventricular pseudoaneurysm, in which the manifestations resulted from pericardial and pleural extension of the inflammatory process associated with contained myocardial rupture. The case demonstrates the need for a high index of suspicion, and the value of imaging techniques to confirm it, in order to proceed with appropriate surgical treatment, and thus modify the course of the disease.

Pseudoaneurysm Development after Free Wall Rupture Post Myocardial Infarction

“…LV pseudoaneurysm cases were reported infrequently in the literature, and it is clinically uncommon due to high risk of rupture, up to 45%, and subsequent remarkable mortality [ 9 ]. On our literature review, the most reported presentations were congestive heart failure (36%), chest pain (30%), and dyspnea (25%); while sudden death was noted in 3% of cases [ 6 , 7 , 8 , 12 , 13 , 14 ]. Myocardial infarction was the most common underlying etiology for LV pseudoaneurysm.…”

“…Myocardial infarction was the most common underlying etiology for LV pseudoaneurysm. Inferior infarcts are considered a higher risk for LV pseudoaneurysm formation than anterior infarcts, and anterior pseudoaneurysms are noted to be less common than posterior pseudoaneurysms [ 6 , 7 , 8 , 12 , 13 , 14 ]. Regardless of the cause and presentation, once identified on echocardiography, goal directed care should be aimed at ensuring hemodynamic stability with intravenous fluids, inotropic agents, and small volume pericardiocentesis, as clinically indicated as a bridge to ultimate cardiac surgery [ 4 , 9 ].…”

Left Ventricular Free-Wall Rupture (Pseudoaneurysm) after Acute Myocardial Infarction in an Asymptomatic Patient

“…Most pseudoaneurysms are diagnosed in the chronic phase months or years after rupture of the ventricular wall, remaining without diagnostic confirmation in the acute phase due to its rapid progression and unfavorable prognosis. 3,4 Pseudoaneurysms tend to grow rapidly and with a high risk of rupture, which can lead to pericardial tamponade and sudden death. The main cause of pseudoaneurysm is acute myocardial infarction; however, it may be less frequently a consequence of chest surgery, trauma, or infection.…”

Infarto do Miocárdio Inferior Evoluído com Pseudoaneurisma do Ventrículo Esquerdo: Um Dilema Diagnóstico

“…O pseudoaneurisma (PA) do ventrículo esquerdo (VE) constitui uma complicação mecânica rara do infarto agudo do miocárdio (IAM). 1 Resulta de ruptura miocárdica, em que o processo hemorrágico é contido pelo pericárdio aderente. Ocorre mais comumente na parede ventricular inferior e posterior, uma vez que a ruptura da parede anterior do ventrículo conduz habitualmente ao tamponamento cardíaco e morte imediata, enquanto que a face ínfero-posterior do coração se apoia sobre o diafragma, facilitando a contenção da cavidade ventricular pelo pericárdio.…”