Linksventrikuläres Pseudoaneurysma nach Mitralklappenersatz

Abstract

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.

Left Ventricular Pseudoaneurysm After Mitral Valve Replacement

“…Echocardiography is the most widely used method for the diagnosis of LV pseudoaneurysms (11). Cardiologists should be aware of such complications, and a precise post-MVR echocardiographic assessment is needed so as not to miss probable small LV pseudoaneurysms.…”

“…Accordingly, 3D echocardiography can be employed as a complementary study to 2D TTE (12). Ventriculography, computed tomography, and magnetic resonance imaging have also been drawn upon for the diagnosis of LV pseudoaneurysms (11). Cardiac computed tomography can delineate the anatomical relationship to both coronary arteries and pulmonary veins.…”

Utilization of live epicardial ultrasound and colour flow Doppler transoesophageal echocardiography to guide an off‐pump repair of a left ventricular pseudoaneurysm

“…It is a rare complication of cardiac surgery including open coronary revascularization, valve surgery, aortic surgery, and transapical approach to transcatheter aortic valve replacement (TA‐TAVR) 1–4 . There are occasional accounts of aneurysm following apical LV venting, and very few published case reports of aneurysm secondary to venting via the right superior pulmonary vein 1,2,4,5 …”

“…[1][2][3][4] There are occasional accounts of aneurysm following apical LV venting, and very few published case reports of aneurysm secondary to venting via the right superior pulmonary vein. 1,2,4,5 Clinical sequelae may include chest pain, dyspnoea, heart failure or spontaneous rupture with pericardial tamponade. 5 The thin wall of the pseudoaneurysm predisposes to high risk of rupture, thus surgical repair is usually necessary 4,5 although if the aneurysm is small and the neck is narrow, conservative management may be feasible.…”

“…1,2,4,5 Clinical sequelae may include chest pain, dyspnoea, heart failure or spontaneous rupture with pericardial tamponade. 5 The thin wall of the pseudoaneurysm predisposes to high risk of rupture, thus surgical repair is usually necessary 4,5 although if the aneurysm is small and the neck is narrow, conservative management may be feasible. 5 Early surgical intervention is indicated when the pseudoaneurysm is enlarging or there is impending rupture.…”