Echocardiographic findings and clinical features of left ventricular pseudoaneurysm after mitral valve replacement

Sakai, Kichiro; Nakamura, Kenji; Ishizuka, Naoko; Nakagawa, Masumi; Hosoda, Saichi

doi:10.1016/0002-8703(92)90981-z

Cited by 57 publications

(34 citation statements)

References 15 publications

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“…Left ventricular pseudoaneurysm (LVPA) due to incomplete or late rupture after mitral valve replacement is very rare [1]. However, if LVPA develops into pericardial tamponade itmay lead to mortality.…”

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confidence: 99%

Linksventrikuläres Pseudoaneurysma nach Mitralklappenersatz

Şahan

Şahan²,

Karamanlıoğlu³

et al. 2015

Herz

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Left ventricular pseudoaneurysm (LVPA) due to incomplete or late rupture after mitral valve replacement is a rare condition but can be life threatening if it develops into perdicardial tamponade. LVPA may develop de novo after the surgical procedure or may be a sequela of an earlier rupture. Clinical presentation includes shortness of breath, heart failure, chest pain, endocarditis, and pericardial tamponade. However, it can also have an asymptomatic course. The recommended treatment for LVPA is surgical repair. Conservative follow-up is an alternative for patients who refuse surgical treatment or are considered high risk for re-operation. We conducted a review of all the available literature on cases of LVPA after mitral valve replacement and present the findings here.

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mentioning

confidence: 99%

Linksventrikuläres Pseudoaneurysma nach Mitralklappenersatz

Şahan

Şahan²,

Karamanlıoğlu³

et al. 2015

Herz

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“…6 Increasingly, surgery is being avoided in asymptomatic patients with comorbidities and incidental pseudoaneurysms, because the surgical mortality rate in these patients might outweigh that of conservative therapy. 6,7 Hence, endovascular repair techniques are an increasingly chosen option in patients with multiple comorbidities or other factors that preclude surgery.…”

Section: Discussionmentioning

confidence: 99%

Direct Percutaneous Repair of Left Ventricular Pseudoaneurysm via Transthoracic Deployment of a Ventricular Septal Defect Closure Device

Moriarty¹,

Harris²,

Vorobiof³

et al. 2015

Texas Heart Institute Journal

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In this case report, we describe direct percutaneous delivery of a muscular-ventricularseptal-defect 4 Dudiy and colleagues 5 have described a transapical approach through the pseudoaneurysmal sac, in 2 patients; however, no images of this approach were provided. We report our initial experience with this technique. Case ReportIn January 2012, a 72-year-old woman initially underwent cardiopulmonary bypass for open graft repair of an ascending aortic dissection, at another hospital. The procedure was complicated by ventricular fibrillation arrest and anterior myocardial infarction. Over the course of the next year, she underwent multiple endovascular procedures for the management of sequelae of a continuous descending and abdominal aortic dissection.In April 2013, the patient underwent open surgical repair (with insertion of a descending aortic graft) of persistent type II endoleaks that had occurred proximally and distally in the thoracic aorta. She then experienced knee numbness, which was attributed to spinal ischemia. At the time, no further sequelae of the aortic procedure-or of cardiopulmonary bypass, including LV cannulation-were noted. However, one month after the surgical procedure the patient developed persistent band-like pain across the lower chest. This prompted contrast-enhanced computed tomographic angiography (CTA), which revealed a large pseudoaneurysm arising from the anterior wall of the LV and surrounding, but discrete from, the left anterior descending coronary artery (LAD) (Fig. 1). The patient then presented at the Interventional Radiology Section for consultation.Given the patient's pain (as illuminated by our subsequent CTA discovery of the large LV pseudoaneurysm), we decided to proceed with closure. Because of scant published experience with the treatment of such a condition, we consulted local specialists in congenital cardiology, cardiothoracic surgery, and interventional cardiology, in order to select the optimal equipment and approach. Rejected options included 1) surgical closure (because of the patient's refusal-together with the high morbidity and mortality rates associated with repeat sternotomy and repair); 2) transfemoral clo-

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“…Sakai et al did not recommend surgery if pseudoaneurysm presented with a narrow neck connecting the left ventricle with the pseudoaneurysm, or if it occurred in the presence of postsurgical mitral valve. 6 Survival of a left ventricular pseudoaneurysm following acute myocardial infarction is rare. Lewis et al suggest that the poor prognosis of pseudoaneurysm is attributed to the thin walls of these structures and to the lack of organised haematoma.…”

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confidence: 99%

Ruptured ventricular pseudoaneurysm

Togni¹,

Hilfiker²,

Folláth³

1998

Heart

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A 73 year old man developed a left ventricular pseudoaneurysm following acute myocardial infarction. Coronary angiography showed triple vessel disease with total occlusion of the right coronary artery. On left ventriculography, a serpentine-like pseudoaneurysm was demonstrated that originated from the posterobasal wall of the left ventricle and extended to the right ventricular free wall. He underwent coronary artery bypass surgery with no plication of the pseudoaneurysm. An organised thrombus was also found within the cavity of the pseudoaneurysm. He was doing well approximately eight months after the operation. The prognosis might be determined by the organised thrombus, the serpentinelike structure of pseudoaneurysm, the coronary revascularisation, and the vigorous medical management. (Heart 1998;80:94-97) Keywords: acute myocardial infarction; pseudoaneurysm; coronary artery bypass surgery Left ventricular pseudoaneurysm is a rare complication of acute myocardial infarction. It occurs as a consequence of rupture of the ventricular free wall and is confined by a portion of pericardium. Early surgical intervention is recommended because there is a risk of rupture even with a small pseudoaneurysm. 1 An electrical or mechanical event is usually the final cause of death. We report a patient who survived with pseudoaneurysm eight months following acute myocardial infarction. Case reportA 73 year old man was admitted to hospital on 11 January 1997 because of prolonged chest pain of 14 hours. Physical examination revealed a heart rate of 97 beats/min, a respiratory rate of 16 breaths/min, and a blood pressure of 154/106 mm Hg. He had no history of cardiovascular disease. No carotid bruit was heard. Auscultation of the lungs showed rales over the right basal area. There was no murmur, gallop, or friction rub. Other physical findings were unremarkable. Chest radiography was essentially normal. Acute inferior myocardial infarction was diagnosed by typical evolutional changes in a 12 lead electrocardiogram and raised creatine kinase (up to 3746 IU/l with MB form of 8.5%). There was no evidence of right ventricular infarction by initial right sided electrocardiogram. Hypotension (blood pressure 85/45 mm Hg) developed two days later and he was managed with aspirin, isosorbide dinitrate, and intravenous dopamine. Transthoracic cross sectional echocardiography (Sonos 2500; Hewlett-Packard, Andover, Massachusetts, USA) was done immediately to detect the possible aetiologies of hypotension. It showed inferior and posterior left ventricular wall hypokinesis and right ventricular free wall akinesis with mild mitral regurgitation. There was no pericardial eVusion, intracardiac shunt, or cardiac rupture.The patient underwent cardiac catheterisation, coronary angiography, and left ventriculography 12 days after admission. Coronary angiography showed triple vessel disease with total occlusion of the right coronary artery. Left ventriculography showed diaphragmatic, posterobasal, apical septal, and posterolateral akinesis...

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Echocardiographic findings and clinical features of left ventricular pseudoaneurysm after mitral valve replacement

Cited by 57 publications

References 15 publications

Linksventrikuläres Pseudoaneurysma nach Mitralklappenersatz

Linksventrikuläres Pseudoaneurysma nach Mitralklappenersatz

Direct Percutaneous Repair of Left Ventricular Pseudoaneurysm via Transthoracic Deployment of a Ventricular Septal Defect Closure Device

Ruptured ventricular pseudoaneurysm

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