Echocardiographic diagnosis of subepicardial aneurysm ruptured into the right ventricle after inferior myocardial infarction

Hironaka, Eiji; Kojima, Shoji; Hongo, Minoru; Fukaya, Yukio; Katagiri, Yuichi; Hiramatsu, Kohzy; Sekiguchi, Morie

doi:10.1016/s0894-7317(97)70094-4

Cited by 6 publications

(5 citation statements)

References 10 publications

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“…7 Six (30%) progressed to frank rupture, five through the inferior wall, and one through the anteroseptum. 1,2,4,9 In six patients, the diagnosis was made only at autopsy. Antemortem diagnosis was made in 14 patients, 12 of whom underwent operative repair.…”

Section: Discussionmentioning

confidence: 99%

“…4,5 In addition to subepicardial aneurysm, this entity has been variously termed ventricular diverticulum, impending rupture, unusual aneurysm, pseudo-false aneurysm, and pseudopseudoaneurysm. 5,6,7,11 Of the 14 reported cases of subepicardial aneurysm diagnosed antemortem, seven were diagnosed by TTE, 3,4,8,9 four by left ventriculography (LVG), 6,7,10,12 one by transesophageal echocardiography (TEE), 3 one by MRI, 5 and one was diagnosed intraoperatively during surgical repair of a ventricu- loseptal defect. 7 The patient currently reported is the only one in whom CT was used to assist in the diagnosis.…”

Section: Discussionmentioning

confidence: 99%

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Subepicardial aneurysm with impending cardiac rupture: A case of antemortem diagnosis and review of the literature

Giltner

Marelli

Halpern

et al. 2007

Clinical Cardiology

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Subepicardial aneurysm is a rare, life‐threatening complication of acute myocardial infarction. Relatively few cases are diagnosed early enough to allow for surgical intervention. Features of this unique aneurysm include abrupt interruption of the myocardium, a narrow neck, and a propensity for progressing to sudden transmural rupture. Literature review reveals only 20 reported cases, several of which were identified postmortem. Since the myocardial burrow may progress to pseudoaneurysm or frank rupture prior to the diagnosis being made, the true incidence is unknown. Invariably, the condition develops as a result of a myocardial rent occurring during the weeks to months following acute infarction, and it generally occurs within an area of thinned, infarcted myocardium. Successful surgical repair has been reported in several cases and is the only therapy shown to prevent progression to frank rupture. Antemortem diagnosis has been reported with transthoracic echocardiography, transesophageal echocardiography, cardiac catheterization, and magnetic resonance imaging. Unfortunately, each of these imaging techniques appears to be limited by either inadequate sensitivity or slow acquisition. There remains no standard of reference among available dIagostic modalities. Rapidly obtained, contrast‐enhanced computed tomography in the proper clinical setting may improve the ability of clinicians to identify this condition during a window of therapeutic opportunity, allowing surgical intervention to prevent fatal cardiorrhexis. Subepicardial aneurysm should be included in the differential diagnosis for patients presenting with chest pain following acute myocardial infarction. Copyright © 2007 John Wiley & Sons, Periodicals, Inc.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Subepicardial aneurysm with impending cardiac rupture: A case of antemortem diagnosis and review of the literature

Giltner

Marelli

Halpern

et al. 2007

Clinical Cardiology

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“…Its wall is composed of epicardium with or without a thin myocardial layer. 1,6 Previous reports indicate that a subepicardial aneurysm develops from the partially ruptured infarcted ventricular wall; the epicardium, sometimes with myocardial remnants, prevents complete rupture, but expands with LV pressure, thus forming this unique aneurysm. There is a high risk of rupture and sudden death, so early diagnosis and surgical treatment are essential.…”

Section: Discussionmentioning

confidence: 99%

“…4,7,8 In addition, a subepicardial aneurysm has been an unusual cause of ventricular septal perforation after myocardial infarction. 1,3,6 However, most of the cases were only diagnosed at surgery or postmortem. Yamaura et al was the first to report 2 cases of subepicardial aneurysm diagnosed by echocardiography and they pointed out the characteristic features of the abrupt interruption of the myocardium, the relatively narrow neck and an intact epicardium.…”

Section: Discussionmentioning

confidence: 99%

Subepicardial Aneurysm Associated With Ventricular Septal Perforation Showing a Normal Coronary Angiogram

Shiraishi¹,

Urao²,

Tsukamoto³

et al. 2003

Circ J

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Subepicardial aneurysm is a rare complication of acute myocardial infarction and the present case was associated with ventricular septal perforation. Echocardiography showed the subepicardial aneurysm adjoining the true apico-anteroseptal aneurysm, with the former being discontinuous with the myocardium at its neck, which was narrower than the diameter of the aneurysm. In addition, color Doppler imaging showed shunt flow from the aneurysm to the right ventricle. Coronary angiography revealed extension only of the anterior descending artery without any discernible stenosis. The apical aneurysm was excised and the defect closed with an epicardial patch. The myocardial infarction was probably caused by coronary spasm. Echocardiography was useful for diagnosing the anatomy and hemodynamic condition of the subepicardial aneurysm.

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“…A subepicardial aneurysm is a rare and life-threatening complication of myocardial infarction. [1][2][3][4][5][6] In most cases, it occurs after inferior infarction, whereas a large anterior infarction often complicates true aneurysms with mural thrombi. 7 It is not clear in this case when the endomyocardial rupture occurred, but it is obvious that anticoagulant therapy increased the risk of rupture.…”

Section: Discussionmentioning

confidence: 99%

Subepicardial aneurysm after anticoagulant therapy for a mural thrombus following anterior myocardial infarction

et al. 2002

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A subepicardial aneurysm became evident in a male patient after anticoagulant therapy. On admission, it appeared to be an old anterior infarction accompanied by a mural thrombus. After warfarin administration, the thrombus disappeared and an echo-free space emerged outside the apical myocardial wall. The echo-free space communicated with the left ventricular cavity through the apical myocardial wall. Emergency surgery was undertaken and the patient survived. The aneurysm was covered with epicardium and there was an endomyocardial rupture of the muscle in the apical wall, which was the entrance of the aneurysm. This case suggests that cautious follow-up with echocardiography is necessary when anticoagulant therapy is selected for thrombi following myocardial infarction.

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Echocardiographic diagnosis of subepicardial aneurysm ruptured into the right ventricle after inferior myocardial infarction

Cited by 6 publications

References 10 publications

Subepicardial aneurysm with impending cardiac rupture: A case of antemortem diagnosis and review of the literature

Subepicardial aneurysm with impending cardiac rupture: A case of antemortem diagnosis and review of the literature

Subepicardial Aneurysm Associated With Ventricular Septal Perforation Showing a Normal Coronary Angiogram

Subepicardial aneurysm after anticoagulant therapy for a mural thrombus following anterior myocardial infarction

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