Repair of Left Ventricular Pseudoaneurysms

Abstract

The outcomes of 3 different methods of repair of left ventricular pseudoaneurysm after myocardial infarction were analyzed retrospectively. The operations were carried out in 22 patients between 1985 and 2008. Repair procedures included primary closure with Teflon-pledgeted sutures, and Dacron or pericardial patches. Overall hospital mortality was 27.3% (2 patients had primary closure, 3 had a Dacron patch, and 1 had a pericardial patch). Mean postoperative bleeding was 885 mL (range, 200-4,800 mL). Mean preoperative and postoperative ejection fractions were 40% (30%-47%) and 48% (30%-65%), respectively. The overall incidence of arrhythmia was 36.4% (8 patients). The incidence of arrhythmia was lowest in the pericardial patch group, but this was not statistically significant. No significant differences in postoperative ejection fraction or hemorrhage were found among the study groups. Mean survival was 61.9 + or - 41.4 months in the 16 hospital survivors. Although the 3 techniques gave similar results, repair with an autologous pericardial patch may offer an advantage in terms of less postoperative arrhythmias.

Severe Mitral Regurgitation After Left Ventricular Pseudoaneurysm Repair

“…1,5,6,14 The mortality is primarily a result of preexisting LV systolic dysfunction in this patient population. 1,5,6,14 The risk of repair is low in comparison to medically managed pseudoaneurysms, which have a mortality rate ranging from 48% to 50%. 7,14 The associated mortality is closely linked to the risk of rupture, which ranges from 30% to 45%.…”

“…[1][2][3][4][5][6][7][8] Other conditions can also lead to pseudoaneurysm formation and include LV trauma, prior LV surgery, LV foreign body infection, myocarditis, and LV posterior wall rupture complicating mitral valve replacement. [1][2][3][4][5][6][7][8] Left ventricular pseudoaneurysms have been associated with the development of significant mitral regurgitation (MR) requiring mitral valve replacement. 9 Since most pseudoaneurysms occur in the basal aspect of the LV, they can distort the geometry of the mitral valve (MV) apparatus and cause MR. Repair of a basal pseudoaneurysm with a patch can decrease MR by improving the geometry of the LV and MV apparatus.…”

Thromboexclusion of an atypical left ventricular pseudoaneurysm

“…Historically, surgical options with patch closure or suture repair have been the safest and most effective solution, although adult data have shown a mortality rate of 27.3–30% . The first PSA closure with percutaneous device repair was described by Clift et al in 2004 .…”

CASE REPORTS Echocardiographic diagnosis of a massive left ventricular pseudoaneurysm: a case report

“…Pseudoaneurysm of the left ventricle (LV) usually develops following ventricular rupture due to transmural myocardial infarction [ 1 ]. Female sex, age, previous stroke, ST elevation, positive cardiac biomarkers, and heart rate at presentation were independently related to heart rupture [ 2 ].…”

“…Massive pericardial tamponade is the most common cause of fatal outcome of patients with free wall rupture, but in some cases, the thrombus becomes organized within the limits of the surrounding tissues and pericardium, which results in pseudoaneurysm formation [ 1 – 4 ]. The risk of pseudoaneurysm rupture is very high, and this makes the prognosis for the disease extremely unfavorable.…”