Contained rupture of left ventricular false aneurysm after acute myocardial infarction secondary to left anterior descending artery embolism

Abstract

P seudoaneurysm of the left ventricle is a rare complication of myocardial infarction (MI), and has a propensity to rupture and cause sudden death. Early diagnosis and surgical exploration is crucial in the management of this pathology. We describe a patient with a contained left ventricular false aneurysm rupture following an acute MI secondary to left anterior descending (LAD) artery embolism. case presentationA 58-year-old woman with a history of osteoporosis, hypertension, appendectomy, chronic obstructive pulmonary disease and bipolar disorder presented with complaints of palpitations, intermittent chest tightness, dizziness and shortness of breath of three weeks duration. On physical examination, she had a heart rate of 160 beats/min, a systemic blood pressure of 117/69 mmHg, no fever and an oxygen saturation of 98% on ambiant air. The jugular venous pressure was elevated at 10 cm H 2 O, lung fields were clear, heart sounds were normal with no rubs and there was slight peripheral edema. A resting electrocardiogram showed atrial flutter. Chest x-ray showed a cardiomegaly and small left pleural effusion. Laboratory data were unremarkable except for a serum troponin level of 0.10 µg/L (normal less than 0.03 µg/L). The patient was admitted overnight with a diagnosis of atrial flutter and a recent myocardial infarct. Medical treatment was initiated with acetylsalicylic acid, heparin, verapamil and digoxin.The next morning, two-dimensional echocardiography revealed a small hyperdynamic left ventricle and a contained rupture at the apex with a circumferential pericardial effusion of 2.5 cm (Figure 1 Left ventricular free wall rupture is a rare complication of acute myocardial infarction and accounts for a significant number of fatalities. Pseudoaneurysm is a variety of left ventricular rupture whereby the pericardium seals the defect, forming the wall of the pseudoaneurysm. The diagnosis is usually confirmed with echocardiography, and emergent surgical repair is required in suspected impending rupture. The present report describes the case of a 58-year-old woman who presented with a myocardial infarction due to distal left anterior descending artery occlusion, complicated by ventricular pseudoaneurysm with impending rupture. The patient had an otherwise normal coronary tree.

Repair of calcified left ventricular pseudoaneurysm of long duration

“…Surgery should include extensive debridement of the pseudoaneurysmal sac, thrombectomy of the ventricle, closure of the remaining defect in the ventricular wall with or without the use of a prosthetic patch, preservation of ventricular geometry [4] and revascularization of the affected coronary arteries. The crucial step is to close the communicating aperture between the true ventricle and pseudoaneurysm cavity.…”

Contained Left Ventricular Free Wall Rupture following Myocardial Infarction

“…In the subacute form, the presentation may evolve over hours, days, or even longer. This form usually presents mainly with pericardial effusion signs and symptoms and may present with dysrhythmias, syncope, prolonged or recurrent chest pain (sometimes of the pericardial type), and heart failure [ 8 ]. In this form, the rupture is often sealed by the epicardium or alternatively by a haematoma in the epicardial surface of the heart, forming a contained myocardial rupture.…”