Real‐Time Three‐Dimensional Echocardiography in Diagnosis of Right Ventricular Pseudoaneurysm after Pacemaker Implantation

Abstract

Right ventricular rupture is a critical cardiac complication associated with cardiac tamponade and death. Occasionally, the site of rupture may be contained by the parietal pericardium and thrombus, thus forming a pseudoaneurysm. Cases of traumatic pseudoaneurysm of the right ventricle have been reported. However, right ventricular pseudoaneurysm following pacemaker implantation has not been previously reported. This case demonstrates two right ventricular pseudoaneurysms following perforation of the right ventricular wall using real-time three-dimensional echocardiography (3DE) after pacemaker implantation although only one definite pseudoaneurysm was diagnosed by routine two-dimensional echocardiography (2DE). We also found that color Doppler 3DE enhanced visualization of the connections between the right ventricle and the pseudoaneurysm. Color Doppler 3DE allowed us to peel away the myocardial tissue and rotate the image to study the jets from different angles. In summary, real-time 3DE and color Doppler 3DE provided excellent visualization of the right ventricular pseudoaneurysm, flow between the ventricle and the pseudoaneurysm, and additional information to that obtained by 2DE.

Chronic giant post-traumatic pseudoaneurysm of the right ventricular outflow tract associated with penetrating ventricular septal fistula

“…Unlike the left ventricular pseudoaneurysms that mostly develop after transmural myocardial infarction rarely followed by cardiac surgery, trauma, and infection, RVOT pseudoaneurysm is an extremely rare complication of cardiac surgical sequelae or endocarditis in published literatures [1][2][3]. Until now, post-traumatic RVOT pseudoaneurysm associated with penetrating ventricular septal fistula has not been documented.…”

Story of a Little Right Ventricular Pseudoaneurysm

“…It differs from their left ventricular equivalents. The low pressure system in RV usually lets spontaneous obliteration of the neck [2]. Although surgery is an option, treatment decision should be individualized depending on the size, volume, filling rate of blood flow and complete tendency to rupture of RV pseudoaneurysm.…”

“…Right ventricle perforation frequently caused by central venous catheters [1], pacemaker implantation [2], endomyocardial biopsy after cardiac transplantation [3,4], pulmonary artery catheterization [5,6,[11][12][13][14][15][16][17], cardiac trauma [7], congenital heart surgery [8], RV myocardial infarction [9].…”

“…Pseudoaneurysms of right ventricle (RV) are extremely rare complications of central venous catheters [1], pacemaker implantation [2], endomyocardial biopsy after cardiac transplantation [3,4], pulmonary artery catheterization [5,6], cardiac trauma [7], congenital heart surgery [8], RV myocardial infarction [9]. This letter aims to describe cardiac imaging (echocardiography, cardiac catheterization) characteristics and lifespan of a small RV pseudoaneurysm which is a very rare finding after application of a Swann-Ganz catheter during cardiac surgery.…”

Unusual Complications of Percutaneous Epicardial Access and Epicardial Mapping and Ablation of Cardiac Arrhythmias

“…Traumatic pseudoaneurysms of the RV have been previously reported after corrective surgery for congenital heart disease, myocardial infarction, cardiac tumors, and endomyocardial biopsy. 9 Large RV pseudoaneurysms often require surgical repair. 10 If uncorrected, they could potentially increase in size and lead to life-threatening complications such as a thromboembolism or rupture.…”