Left Ventricular Pseudoaneurysm: An Overview of Diagnosis and Management

Abstract

Left ventricular pseudoaneurysm is a rare but life-threatening disorder that is frequently reported secondary to myocardial infarction or cardiac surgery. In this article, we chronicle the case of a patient with no prior risk factors who presented with a 2-week history of nonexertional atypical left chest pain. Apical 2-chamber transthoracic echocardiography revealed an unexpected outpouching of basal inferoseptal wall of the left ventricle, which had a narrow neck and relatively wide apex. The patient was diagnosed with left ventricular pseudoaneurysm and medical therapy was initiated. He refused to undergo the surgical intervention and subsequently, he was discharged from the hospital in stable condition. This article illustrates that physicians should be vigilant for atypical presentations of left ventricular pseudoaneurysm, and a high index of suspicion should be maintained for this stealth killer while performing appropriate diagnostic imaging. Additionally, we review the currently available approaches to diagnosis and management in these patients.

Spontaneous Right Ventricular Pseudoaneurysms and Increased Arrhythmogenicity in a Mouse Model of Marfan Syndrome

“…We furthermore observed a lack of cardiomyocytes in the walls of both types of cardiac lesions. Based on these characteristics, the lesions can be classified as pseudoaneurysms of the RV free wall [ 34 , 35 , 36 ]. We hypothesize that the etiology of the RV pseudoaneurysms in the Fbn1 mgR/mgR mouse model can be assigned to the reduced ability of the remaining fibrillin-1 fibers to maintain strong structural connections between adjacent myocardial muscle lamellae.…”

“…Secondly, detecting small lesions in a trabeculated right ventricular wall with conventional imaging techniques is particularly challenging and will require dedicated high-resolution modalities. Thirdly, these lesions may have remained undetected so far because autopsies are not routinely performed on deceased MFS patients, combined with the fact that severe (cardiovascular) forms of MFS in humans are rare [ 34 , 35 , 36 ]. With this research we hope to increase awareness for this new myocardial manifestation of MFS, which could potentially lead to new data regarding the prevalence of this type of cardiac lesions in MFS patients and other MFS mouse models.…”

“…Similar to the variable presence of dilated cardiomyopathy in Fbn1 mgR/mgR mice, it is likely that this novel cardiac manifestation is dependent on genetic modifiers associated with the genetic background, possibly explaining why this phenotype has not been observed previously in another study using mouse models of MFS. Further research is also warranted to investigate whether these ventricular pseudoaneurysms in a MFS mouse model are prone to rupture or increase the risk of arrhythmias and thromboembolism, as is known in the human setting of ventricular pseudoaneurysms [ 34 , 35 ].…”

Acute respiratory distress secondary to a huge chronic left ventricular pseudo-aneurysm

“…Pseudo-aneurysms of the left ventricle are a rare complication of a myocardial infarction, often of the inferior wall (1, 2). Pseudo-aneurysms have also been reported to occur as complication of cardiac surgery, endocarditis and blunt or penetrating trauma (1, 3). Unlike a true aneurysm, a pseudo-aneurysm occurs when there is complete rupture of the myocardial wall contained by an area of pericardium adherent to the epicardium (4).…”

“…The thin wall of a pseudo-aneurysm means that they are much more likely to rupture than a true aneurysm, with historic reported rates of rupture between 30 and 45% (1, 3, 5). However, a single study containing ten patients who were medically managed, demonstrated no instances of rupture at four years.…”