Diagnosing left ventricular aneurysm from pseudo-aneurysm: a case report and a review in literature

Abstract

Rupture of the free wall of the left ventricle (LV) is a catastrophic complication occurring in 4% of patients after myocardial infarction (MI) and in 23% of those who die of MI. Rarely the rupture is contained by an adherent pericardium creating a pseudo-aneurysm. This clinical finding calls for emergency surgery. If no ruptures are detectable and myocardium wall integrity is confirmed, we are in the presence of a true aneurysm, which can be treated by means of elective surgery. Differentiation between these two pathologies remains difficult. We report the case of a patient with a true aneurysm, initially diagnosed as pseudo-aneurysm at our institution; we have reviewed the literature on this difficult diagnosis and outlined characteristic findings of each clinical entity.

Successful surgical repair of a chronic left ventricular pseudoaneurysm

“…It occurs most frequently in patients with complete left anterior descending artery occlusion and a large area of necrosis. Intravitally, it occurs more frequently in the area vascularized by the right and circumflex arteries, due to the high mortality associated with left anterior descending wall aneurysms [2]. A number of factors predispose to this complication, including elderly age, female sex, arterial hypertension, anterior wall infarction, fibrinolytic treatment, lack of previous coronary episodes, as well as the administration of steroids and non-steroidal anti-inflammatory medications during the acute phase of the infarction.…”

Simultaneous Left Ventricular Pseudo-Aneurysm and Ventricular Septal Rupture After a Non-ST Segment Myocardial Infarction

“…The aneurysmal sac is composed of myocardial fibers and has a wide communication between the LV cavity and the sacular deformity [20]. Eventually this area will develop hypo and akinesia with increase risk of thrombus formation and embolic events [21].…”

Left ventricular pseudoaneurism

“…4,8 Primena reperfuzione terapije, pogotovo primarne perkutane koronarne intervencije imala je najveći uticaj na smanjenje učestalosti ove teške mehaničke komplikacije akutnog infarkta miokarda. 9 Klinički profil pacijenta i predisponirajući faktori za nastanak rupture su: stariji od 55 godina, žene, hipertoničari, retka angina, prvi infarkt, kasna hospitalizacija zbog pogrešne dijagnoze (zbog sinkope i hipotenzije pacijent često bude upućen neurologu), fizička aktivnost i hipertenzija u prvih 10-24 sati infarkta, prolongirani retrosternalni bol, perzistentna ST elevacija, ponovni jak bol i ST reelevacija, višesudovna koronarna bolest i transmuralni infarkt, nekad mali lateralni infarkt, kasna fibrinolitička terapija, kortikosteroidi i nesteroidni antireumatici u terapiji.…”