Pseudoaneurysms of the Heart

Hulten, Edward; Blankstein, Ron

doi:10.1161/circulationaha.111.043984

Cited by 102 publications

(113 citation statements)

References 15 publications

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“…Recognition of pseudoaneurysm, however, is contingent upon ability to visualize the ostium of the connecting orifice; continuous and pulse wave Doppler as well as color flow mapping are potential alternatives but regrettably have limited sensitivity [2,4,17]. Though angiography is historically the standard, cardiac CT and MRI offer new, noninvasive technique, high spatial resolution, tissue characterization, and improved visualization of segments that may be difficult to see on echocardiography [4]. In our own case, as outlined above, these procedures proved vital towards accurate diagnosis.…”

Section: Discussionmentioning

confidence: 99%

“…Indeed, while left ventricular pseudoaneurysms are a rare complication in and of themselves, right ventricular pseudoaneurysms are still more uncommon [4]. Following a literature review, published case reports of these right ventricular anomalies have been demonstrated to develop from lipoma [5], postcardiac surgery [6][7][8][9], following device lead extraction [10], in the infectious setting [11,12], after remote myocardial infarction [2], as a complication of endomyocardial biopsy [3], and subsequent to penetrating chest wall trauma [13][14][15].…”

Section: Introductionmentioning

confidence: 99%

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An Incidentally Detected Right Ventricular Pseudoaneurysm

Gaddipati

Martin

Valenzuela

et al. 2017

Journal of the American College of Cardiology

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Ventricular pseudoaneurysm is an uncommon, potentially fatal complication that has been associated with myocardial infarction, cardiac surgery, chest trauma, and infectious processes. Diagnosis can be challenging, as cases are rare and slowly progressing and typically lack identifiable features on clinical presentation. As a result, advanced imaging techniques have become the hallmark of identification. Ahead, we describe a patient who presents with acute decompensated heart failure and was incidentally discovered to have a large right ventricular pseudoaneurysm that developed following previous traumatic anterior rib fracture.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

An Incidentally Detected Right Ventricular Pseudoaneurysm

Gaddipati

Martin

Valenzuela

et al. 2017

Journal of the American College of Cardiology

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“…1 In our patient, preexisting myocardial damage attributable to cardiac intervention or cardiac surgery could be excluded. Myocardial infarction as a possible reason for pseudoaneurysm formation was highly unlikely for the following reasons.…”

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confidence: 89%

Spontaneous Intramural Hematoma of the Left Ventricle

et al. 2016

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A 66-year-old man was admitted to our emergency department for treatment of acute thromboses of multiple abdominal vessels (abdominal aorta, splenic artery and vein, inferior mesenteric artery, and portal vein). Chest computed tomography (CT) performed 2 days before admission showed no abnormality in the left ventricular myocardium (Figure 1). Laboratory findings suggested a hematologic disorder, and therapeutic anticoagulation with heparin was initiated. A bone marrow biopsy was conducted that revealed chronic myelomonocytic leukemia as the underlying disease. Three days after admission, the patient reported severe chest pain. Blood testing revealed elevated levels of high-sensitivity troponin T (155 ng/L [normal <14 ng/L]), normal levels of creatine kinase (30 U/L [normal<190 U/L]), activated partial thromboplastin time of 78 seconds (therapeutic activated partial thromboplastin time range, 45-75 seconds), and a slightly increased international normalized ratio of 1.3 (normal <1.2). ECG showed sinus tachycardia but no changes indicating myocardial ischemia. Triple rule-out CT was performed and excluded relevant coronary artery disease (Figure 2), pulmonary embolism, and abnormalities of the aorta. Instead, hemopericardium and a focal, expansive, lens-shaped hypodense lesion in the inferolateral wall of the left ventricle (LV) was found (Figure 3), which was not seen on the foregoing chest CT (see Figure 1). Subsequent transthoracic echocardiography confirmed pericardial tamponade, and an emergency pericardiocentesis was conducted. This was unsuccessful, and therefore surgical subxiphoidal pericardial drainage was performed. Follow-up transthoracic echocardiography 6 days after the intervention showed a small residual pericardial hematoma that was hemodynamically relevant. In addition, a new pseudoaneurysm in the inferolateral wall of the LV at the site of the previous hypodense mass was detected (Figure 4 and Movie I in the online-only Data Supplement) and confirmed by cardiac CT (Movie II in the online-only Data Supplement). Because of the small size of the pseudoaneurysm and the associated risk of operative treatment, conservative management was decided. Seven days later, follow-up CT showed a growing pseudoaneurysm ( Figure 5), and the patient was scheduled for urgent operation. The pseudoaneurysm was resected (Figure 6) and the defect in the LV wall was closed by using a bovine pericardial patch. Transthoracic echocardiography performed 5 days after surgery showed regular postoperative results (Movie III in the online-only Data Supplement) with a normal LV ejection fraction of 67%. Cardiac CT, which was also performed 5 days after surgery, similarly showed normal postoperative findings with no residual pseudoaneurysm. The patient recovered well and was transferred to a rehabilitation hospital 7 days after surgery.Pseudoaneurysm formation is a well-known complication after myocardial infarction, cardiac intervention, or cardiac surgery.1 In our patient, preexisting myocardial damage attributable to cardiac ...

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“…Pseudoaneurysms can be clinically silent until they present with sudden rupture and death. Doppler can be used to demonstrate the presence of bidirectional flow, and the extent of flow may be a risk factor for rupture and sudden death 1 2. The images represent the commonest form of pseudoaneurysm localised to the inferior wall of the LV (see online supplementary figure panels A, B and media 2A, B).…”

Section: Answer: Bmentioning

confidence: 99%