Pseudoaneurysm with left-to-right shunt in a patient with myocardial infarction: evaluation by three-dimensional echocardiography

Maeba, Hirofumi; Miyasaka, Yoko; Kotaka, A.; Tsujimoto, Satoshi; Yuasa, Fumio; Iwasaka, Toshiji

doi:10.1007/s10396-012-0355-x

Cited by 2 publications

References 11 publications

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Nonbacterial thrombotic endocarditis demonstrated by repeat echocardiography

et al. 2013

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We report a case of nonbacterial thrombotic endocarditis (NBTE) in a patient with bladder cancer presenting with multiple cerebral infarctions. Initial transthoracic and transesophageal echocardiography did not show any abnormalities. However, repeat transthoracic and transesophageal echocardiography demonstrated a vegetation on the anterior leaflet of the mitral valve with mild mitral regurgitation and no evidence of leaflet destruction. Persistent high-grade fevers and leukocytosis were observed. The patient was suspected to have infective endocarditis. However, abdominal ultrasound and computed tomography scan revealed multiple metastatic masses, and serial blood cultures were negative. The patient was ultimately diagnosed with NBTE associated with multiple metastases of bladder cancer. This case suggests that even if echocardiography does not initially demonstrate any abnormalities in patients with embolism, it must be repeated at the recurrence of embolism, and that even if clinical signs of infection are documented, NBTE should be suspected in any cancer patient with thromboembolic events.

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Nonbacterial thrombotic endocarditis demonstrated by repeat echocardiography

et al. 2013

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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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Pseudoaneurysm with left-to-right shunt in a patient with myocardial infarction: evaluation by three-dimensional echocardiography

Cited by 2 publications

References 11 publications

Nonbacterial thrombotic endocarditis demonstrated by repeat echocardiography

Nonbacterial thrombotic endocarditis demonstrated by repeat echocardiography

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

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