Pseudoaneurisma de ventrículo esquerdo associado a insuficiência mitral grave complicando infarto agudo do miocárdio ínfero-látero-dorsal

Abstract

We described a case of left ventricular pseudoaneurysm associated to a severe mitral regurgitation, complicating a inferolaterodorsal acute myocardial infarction. The lesion was found in a routine echocardiogram during the in-hospital follow-up. The well-succeeded surgical strategy and the good clinical evolution of the patient were distinguished.The left ventricular pseudoaneurysm after acute myocardial infarction is a very rare complication and it is not frequently diagnosed. However, its appearance gives rise to a bleak prognostic to its carriers, who can evolve quickly to death. Opposing to the rupture of the free ventricular wall, the pericardial adherences of pseudoaneurysm have the intraventricular blood, which gives a less acute nature to such condition and allows for the therapeutic intervention to be performed before a casual fatal outcome. So, it is important to be aware about the risk of appearance of postinfarction pseudoaneurysm, in order to not to resort to more suitable diagnostic methods and correct the condition rapidly after its confirmation. Case reportA 67-year-old female patient, hypertensive, carrier of diabetes mellitus and irregular control dyslipidemia, was admitted to the Emergency Room of Instituto do Coração with a severe pain on the left shoulder for 10 hours. The clinical features started at rest, associating to nausea, vomit and cold sudoresis. The echocardiogram indicated the presence of an ongoing inferolaterodorsal acute myocardial infarction, with affection of the right ventricle. The coronary angiography of urgency revealed a complete occlusion of the left coronary artery in its proximal portion, in addition to luminal obstructions of 70% in the mid-third of the anterior intraventricular artery (anterior descendent), 90% in the mid-portion of its first diagonal branch and 90% in the first marginal branch of the circumflex artery. The patient was submitted to a percutaneous transluminal angioplasty of the left coronary with a stent implant, from which a distal coronary flow was obtained, and classified as TIMI II. The procedure was complicated by thrombosis and distal embolization with occlusion of the posterior ventricular branch of the right coronary. The patient evolved during the initial stage of hospitalization in Killip Class II, keeping herself dyspneic to little strains. The echocardiographic assessment on the 2 nd day postacute myocardial infarction showed akinesia of the left ventricular lower and posterior walls, associated to side and septal hypokinesia, which led to an important left ventricular systolic dysfunction (ejection fraction through the method of Simpson=35%). The right ventricle showed normal systolic function. At the Doppler, the mitral insufficiency was moderate. Progressively, the patient improved her clinical condition, with the use of conversion enzyme inhibitor, hydralazine, nitrate and diuretics. There was a reduction of the tiredness, which still persisted to moderate strains, and the pulmonary rales disappeared. The transthoracic echocardiogram...

Unruptured left ventricular pseudoaneurysm after silent myocardial infarction with severe mitral valve regurgitation

“…Mitral failure associated with pseudoaneurysm is mainly caused by three factors: mitral ring dilatation, restriction of the posterior mitral leaf let due to ventricular dilatation, and loss of contraction of the ventricular wall. [11,12] Repair of the pseudoaneurysm, as in this case, may support the restoration of ventricular geometry and reestablish mitral valve function.…”

Unruptured Left Ventricular Pseudoaneurysm After Silent Myocardial Infarction with Mitral Valve Regurgitation

“…Mitral failure associated with pseudoaneurysm is caused by mainly three factors: mitral ring dilatation, restriction of posterior mital leaflet due to ventricular dilatation, loss of contraction of ventricular wall. [7] Repair of pseudoaneurysm as in this case, may support to restoration of ventricular geometry and reestablishing mitral valvar function.ConclusionsLeft ventricular wall rupture is a mortal complication occuring 4% of patients after acute MI [5]. Rarely pseudoaneurysm information can be seen with adherent pericardial tissue.…”

Infarto do Miocárdio Inferior Evoluído com Pseudoaneurisma do Ventrículo Esquerdo: Um Dilema Diagnóstico

“…Ocorre mais comumente na parede ventricular inferior e posterior, uma vez que a ruptura da parede anterior do ventrículo conduz habitualmente ao tamponamento cardíaco e morte imediata, enquanto que a face ínfero-posterior do coração se apoia sobre o diafragma, facilitando a contenção da cavidade ventricular pelo pericárdio. [1][2][3] Os métodos de imagem são cruciais para estabelecer o diagnóstico. A ecocardiografia transtorácica (ETT) e transesofágica permite o diagnóstico definitivo em 26% e 75% dos casos, respectivamente.…”