Submitral left ventricular pseudoaneurysm after mitral valve replacement

Abstract

A 60-year-old woman who underwent mitral valve replacement 3 months ago gradually developed dyspnea on exertion.Catheterization showed a large posterolateral left ventricular aneurysm (Fig. 1). Multislice CT confirmed the diagnosis (Fig. 2). www.elsevier.com/locate/ejcts European Journal of Cardio-thoracic Surgery 35 (2009) 728 Fig. 2. Multislice CT (a) in a four-chamber view shows the submitral pseudoaneurysm of the left ventricle, (b) short axis view shows the posterior aneurismal dilatation of the left ventricle, (c and d) coronal views show the rhomboid aneurysm correlated with the shape on catheterization. The origin and course of the Cx were normal. Iatrogenic intraoperative left circumflex injury and subsequent infarction was the cause of pseudoaneurysm. Aneurysmectomy was performed with good postoperative cardiac function.Fig. 1. Left ventriculography shows the abnormal accumulation of contrast medium. Note the prosthetic valve.

Linksventrikuläres Pseudoaneurysma nach Mitralklappenersatz

“…The most common clinical presentation in the reviewed articles was shortness of breath/heart failure. Dyspnea and heart failure were the major symptoms for 35 patients [2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20]. Six patients had been asymptomatic at the time of diagnosis [21][22][23][24][25][26], whereas six other patients had described chest pain [3,11,12,19,27,28].…”

“…Transthoracic echocardiography (TTE) was performed on 49 patients. Definitive diagnoses were made for 43 patients using TTE, as well as transesophageal echocardiography [2,6,8,10,[16][17][18]23], computed tomography [2-8, 11, 14, 16, 19, 21-23, 25-29], and heart catheterization [6,7,11,15,20,21,23,24,27] as additional visualization methods. Suspected pericardial pathology was observed in four patients with TTE; the diagnosis was confirmed by transesophageal echocardiography [8] and computed tomography [7,11,27] in these patients.…”

Left Ventricular Pseudoaneurysm

“…LVPAs can occur as a complication of myocardial infarction (MI), cardiac surgery, infective endocarditis, chest trauma, tuberculosis, rheumatoid arthritis, Kawasaki's disease and Behcet's disease. The most common etiology of LVPAs is myocardial infarction (10). One third of LVPAs resulted from a surgical procedure, most often mitral valve replacement (10).…”

“…The most common etiology of LVPAs is myocardial infarction (10). One third of LVPAs resulted from a surgical procedure, most often mitral valve replacement (10).…”

“…LVPA is prone to rupture (53). Sudden death accounted for 3% of the onset symptoms of LVPA (10). Mitral regurgitation may complicate posterior pseudoaneurysm, usually due to distortion or partial rupture of the posteromedial papillary muscle (54).…”