Transcatheter Closure of Complex Post-Myocardial Infarction Left Ventricular Pseudoaneurysm and Unique Post-Traumatic Right Ventricular Pseudoaneurysm

Abstract

Ventricular pseudoaneurysm (PSA) is a rare, yet life-threatening complication of myocardial infarction, cardiac surgery, and transcatheter valve replacement. Although conventional surgery is the preferred treatment strategy, transcatheter closure has emerged as an effective alternative in selected candidates. In this report, we describe successful transcatheter closure of two unique cases of ventricular pseudoaneurysm (PSA): first, a complex post-myocardial infarction left ventricular PSA (LVPSA) with multi-communications, and second, a case of post-traumatic right ventricular PSA (RVPSA) following blunt chest injury caused by domestic violence.

Clinical Manifestation, Timing Course, Precipitating Factors, and Protective Factors of Ventricular Free Wall Rupture Following ST-Segment Elevation Myocardial Infarction

“…Unsurprisingly, there was no consensus on the prevention and treatment of FWR. [6][7][8][9][10] FWR is associated with a high mortality from electromechanical dissociation or pericardial tamponade and is often unresponsive to resuscitative maneuver. Our knowledge of FWR is limited to case reports and retrospective studies frequently combining it to ventricular septal rupture (VSR) and/or papillary muscle rupture (PMR).…”

Systematic review and meta-analysis of the mechanical complications of ischemic heart disease: papillary muscle rupture, left ventricle rupture and post-infarct ventricular septal defect

“…The search strategy revealed 3,051 unique articles that underwent title and abstract review, which led to 2,905 studies being excluded. Of the remaining 146 studies, 15 studies were included in the qualitative synthesis of the percutaneous management of PMR (7-21), 4 were included in the qualitative analysis of the percutaneous management of LV FWR (22)(23)(24)(25), 7 studies defined the outcomes of the percutaneous management of LV pseudoaneurysm (15,(26)(27)(28)(29)(30)(31)(32)(33)(34)(35)(36)(37)(38)(39)(40)(41) and 25 were included in the quantitative metaanalysis of the primary percutaneous management of post-MI VSD (42-66) (Table 1) (Figure S1).…”

“…Seventeen studies described techniques for ventricular pseudoaneurysm management, including 19 patients with an age range of 47-85 (15,(26)(27)(28)(29)(30)(31)(32)(33)(34)(35)(36)(37)(38)(39)(40)(41). Two patients presented with cardiogenic shock (15,39), eight with dyspnoea (15,26,28,31,33,34,38,40) and one required mechanical circulatory support (39).…”

“…Seventeen studies described techniques for ventricular pseudoaneurysm management, including 19 patients with an age range of 47-85 (15,(26)(27)(28)(29)(30)(31)(32)(33)(34)(35)(36)(37)(38)(39)(40)(41). Two patients presented with cardiogenic shock (15,39), eight with dyspnoea (15,26,28,31,33,34,38,40) and one required mechanical circulatory support (39). Six patients underwent subsequent percutaneous coronary intervention (33,34,36,37,39,41) and 12 were diagnosed with a STEMI (15,26,27,(31)(32)(33)(34)(35)(36)(37)(38)41) (Table 6).…”

“…Two patients presented with cardiogenic shock (15,39), eight with dyspnoea (15,26,28,31,33,34,38,40) and one required mechanical circulatory support (39). Six patients underwent subsequent percutaneous coronary intervention (33,34,36,37,39,41) and 12 were diagnosed with a STEMI (15,26,27,(31)(32)(33)(34)(35)(36)(37)(38)41) (Table 6). Due to significant comorbidities, including previous cardiac surgery, COPD, diabetes and previous CVA, all patients underwent percutaneous repair with a closure device.…”