Two-dimensional echocardiographic recognition of left ventricular pseudoaneurysm.

Catherwood, Edward; Gs, Mintz; Kotler, Morris N.; Parry, Wayne R.; Segal, Bernard L.

doi:10.1161/01.cir.62.2.294

Cited by 159 publications

(33 citation statements)

References 27 publications

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“…The diagnostic echocardiographic features are that the orifice of the pseudoaneurysmal cavity is a distinct discontinuity in the LV wall, and that the ratio (Omax/Dmax) is <0.5 for pseudoaneurysms, and >1.0 for true aneurysms. 2,5,6 Echocardiography of the present patient showed a relatively narrow necked aneurysm with an abrupt thinning at the hinge point and freely moving torn pieces. The ratio was 0.6.…”

Section: Discussionmentioning

confidence: 55%

Echocardiographical Demonstration of a Progressively Expanding Left Ventricular Aneurysm Preceded by Endomyocardial Tearing

Ikeda

Yasu²,

Yamada³

et al. 2001

Jpn Circ J

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70-year-old blind woman was admitted to hospital because of an initial episode of chest pain lasting 12 h. She had been receiving insulin therapy for diabetes mellitus. An ECG showed ST-segment elevation in the precordial leads (V1-5), I and aVL indicating an anteroseptal acute myocardial infarction (AMI). Emergency coronary arteriography revealed diffuse stenosis of the right and left coronary arteries with severe calcification, and total occlusion at the middle portion of the left anterior descending artery. Blood flow was not apparent in the lesion after balloon inflation because the guide wire had passed through the false lumen. Left ventriculography showed dyskinetic movement at the antero-apex, and hyperkinesis at the other sites (Fig 1A,B). Systolic blood pressure was strictly kept below 120 mmHg by continuous drip infusion of nitroglycerine and oral administration of isosorbide mononitrate (20 mg/day) and imidapril hydrochloride (1.25 mg/day) to prevent rupture of the left ventricle (LV). Echocardiography on the 10th day after onset (Fig 2A,B) showed an aneurysm forming in the antero-apical wall of the LV with moderate pericardial effusion. Along the border between the infarcted and non-infarcted areas, the myocardial wall thickness abruptly decreased and small, freely moving torn pieces were seen (Fig 2A,B). The ratio of the maximal internal diameter of the aneurysm neck (Omax)/the maximal parallel internal diameter of the LV sac (Dmax) was 0.61.The patient underwent an urgent operation on the 13th daybecause of a highly suspected LV pseudoaneurysm. There were 120 ml of slightly bloody effusion in the pericardial cavity and a hemorrhagic infarcted lesion on the surface of the LV apex. Although there was no active bleeding point, fibrin glue and oxycellulose were affixed to this lesion. 1 Two months after the surgery, the patient was readmitted because of dyspnea on mild exertion. The LV volume (left ventricular end-diastolic volume index (LVEDVI): 194 ml/m 2 , left ventricular end-systolic volume index (LVESVI): 134 ml/m 2 , ejection fraction (EF): 31%) had increased to more than twice the volume seen at the onset of AMI (LVEDVI: 89 ml/m 2 , LVESVI: 54 ml/m 2 , EF: 39%) (Fig 1). She successfully underwent Dor's operation to reduce the LV volume. The histological findings of residual small myocyte islands and fibrotic epicardial lesion in the resected A 70-year-old woman with acute myocardial infarction (AMI) had a narrow necked left ventricular (LV) aneurysm and pericardial effusion. Although there had been no obvious sign of pseudoaneurysm at the first operation on the 13th day after onset, LV volume increased so dramatically that dyspnea on mild exertion was induced only 2 months after the onset of AMI. She underwent Dor's operation for the expanded LV aneurysm. The histological findings of the resected tissue, which were fibrotic epicardial lesion with small myocyte islands, indicated a true aneurysm. The ultrasound manifestation of a narrow necked aneurysm with abrupt thinning of the myocardium at t...

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Section: Discussionmentioning

confidence: 55%

Echocardiographical Demonstration of a Progressively Expanding Left Ventricular Aneurysm Preceded by Endomyocardial Tearing

Ikeda

Yasu²,

Yamada³

et al. 2001

Jpn Circ J

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“…Currently, echocardiography (transthoracic or transesophageal) is the diagnostic standard [4] for diagnosis of pseudoaneurysms as it has the ability to visualize the heart in different planes and distinguish the myocardium from other structures. Characteristic echocardiographic findings suggestive of a false aneurysm include a sharp discontinuity of endocardial image at the site of pseudoaneurysm communication with the left ventricular cavity, a saccular or globular contour of the false aneurysmal chamber and the presence of a relatively narrow orifice compared with the diameter of the aneurysm fundus [5] . Two other characteristics of pseudoaneurysm include systolic expansion of the aneurysmal cavity and displacement of other cardiac chambers.…”

Section: Discussionmentioning

confidence: 99%

Left Ventricular Pseudoaneurysm - A rare condition and its Imaging

Ganie¹,

Lone²,

Wahid³

et al. 2017

Journal of Cardiology and Therapy

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“…They are associated with a 35%-to-40% risk of subsequent progression. 16 Subepicardial aneurysm is an incomplete myocardial tear that involves all but the epicardial layer of the myocardium. This rare disease entity is thought to be a pre-rupture state.…”

Section: Discussionmentioning

confidence: 99%

Prompt Recognition of Left Ventricular Free-Wall Rupture Aided by the Use of Contrast Echocardiography

Okabe¹,

Julien²,

Kaliyadan³

et al. 2015

Texas Heart Institute Journal

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L eft ventricular free-wall rupture (LVFWR) is a life-threatening sequela of acute myocardial infarction. Contrast-enhanced echocardiography can be used urgently at the bedside to identify LVFWR. Early recognition is paramount, because emergency surgical correction is the only treatment. We describe the use of contrast-enhanced echocardiography in a patient who sustained pulseless electrical activity 5 days after a myocardial infarction (MI). Direct views of a tear in the myocardium enabled rapid confirmation of the diagnosis and expeditious surgical treatment. Case ReportIn January 2013, a 59-year-old woman with hypertension and hypercholesterolemia presented at another hospital with a 2-day history of chest pain. She was treated for non-ST-segment-elevation MI. Her initial serum troponin T level was 0.96 ng/mL (normal, <0.01 ng/mL). An electrocardiogram revealed ST-segment elevation in lead aVL, borderline but nondiagnostic ST-segment elevation in adjacent lead I, rsR′ in lead V 2 , and ST-segment depression in the anterolateral and inferior leads (Fig. 1). The patient was admitted to the intensive care unit and was given aspirin, low-molecularweight heparin, a glycoprotein IIb/IIIa inhibitor, and a nitroglycerin infusion. Her serum troponin T level peaked at 3.79 ng/mL.The patient was transferred to our hospital the next day for elective cardiac catheterization. An electrocardiogram revealed a recent posterolateral infarction (Fig. 2). Coronary angiograms showed an occluded left circumflex coronary artery; faint collateral vessels from a patent, dominant right coronary artery; a 70% stenosis of the first diagonal branch; and a 90% stenosis of the right posterior descending artery (RPDA). Left ventriculograms revealed severe hypokinesis of the inferolateral wall and overall mild left ventricular (LV) dysfunction. No intervention was performed, because the patient was no longer symptomatic and was well beyond 24 hours from symptom onset and presentation.On hospital day 3, the patient sustained a retroperitoneal hemorrhage and was transfused with 2 units of packed red blood cells. On hospital day 5, she became acutely unresponsive and pulseless while conversing with her family. Advanced cardiac life support was initiated immediately. She remained hemodynamically unstable and needed intravenous fluids and vasopressors. A bedside transthoracic echocardio-

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Two-dimensional echocardiographic recognition of left ventricular pseudoaneurysm.

Cited by 159 publications

References 27 publications

Echocardiographical Demonstration of a Progressively Expanding Left Ventricular Aneurysm Preceded by Endomyocardial Tearing

Echocardiographical Demonstration of a Progressively Expanding Left Ventricular Aneurysm Preceded by Endomyocardial Tearing

Left Ventricular Pseudoaneurysm - A rare condition and its Imaging

Prompt Recognition of Left Ventricular Free-Wall Rupture Aided by the Use of Contrast Echocardiography

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