Postinfarction Left Ventricular Pseudoaneurysm

Abstract

Summary:Left ventricular wall rupture after myocardial infarction is a mechanical complication that may result in a pseudoaneurysm. Between January 1994 and October 1996, false or pseudoaneurysms were detected in 6 (0.0026%) of 2,600 consecutive patients (4 women, 2 men; mean age 59.4 years) undergoing cardiac catheterization at University Medical School, Debrecen, Hungary. All patients had a history of cardiovascular disease, with diagnosis of pseudoaneurysm confirmed by echocardiography. The average time from the occurrence of acute infarction to diagnosis was 37.0 days (range 3-80 days). All patients were in New York Heart Association functional class IV congestive heart failure; in four patients cardiogenic shock was present. Five patients underwent coronary angiography, which demonstrated multivessel disease and occlusion of the infarct-related artery (TIMI 0) without adequate collateral circulation (grade 0-1). Five patients had surgical repair of the false aneurysm, and, in three patients, concomitant coronary bypass grafting was performed. The 2-year mortality rate for all patients was 50%. Early diagnosis of false aneurysm is facilitated by echocardiography, and coronary angiography is required before surgery. Early surgical correction with coronary revascularization is advised.

Left ventricular pseudoaneurysm causing coronary angiography images resembling myocardial bridging

“…Left ventricular pseudoaneurysms usually present with symptoms and need surgical intervention [9,10], however, 10% of the cases seem asymptomatic and diagnosed accidentally [2]. In our patient; cardiac enzymes, electrocardiography, echocardiography, angiography and ventriculography did not verify evidence of myocardial infarction, and he did not have a history of surgery, trauma, infection or tumor.…”

Ventricular pseudoaneurysm after subacute myocardial infarction

“…In general, ventricular pseudoaneurysms are a catastrophic complication requiring urgent surgery [5,6], however favourable long-term outcome in patients treated conservatively has been reported [18,19]. The risk of rupture and embolism should be weighed against the operative risk, which is estimated to be 25-28% [20][21][22].…”

“…Early and accurate identification has always been emphasized because of the high incidence of rupture and subsequent death [4]. Urgent surgical repair is therefore advised [5,6]. Symptoms are often nonspecific or patients can be asymptomatic [7].…”

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

“…In a small number of cases, dilatation and remodeling of the damaged ventricular wall without rupture may lead to ventricular aneurysm formation [4]. Conversely in approximately 0.2-0.3% of infarctions, complete cardiac rupture is contained by adjacent tissue, most often the pericardium, forming a pseudo-aneurysm [5]. Differentiation between left ventricular (LV) aneurysm and pseudo-aneurysm is difficult, yet it is extremely important given the greater propensity for rupture of the latter, hence requiring emergent surgical repair [1,6,7].…”