Surgical and Conservative Treatment of Post-infarction Left Ventricular Pseudoaneurysm

Abstract

BackgroundPost-infarction left ventricular (LV) pseudoaneurysm is a rare mechanical complication of myocardial infarction that carries a substantial risk of sudden rupture. The purpose of this study was to compare the surgical results of post-infarction LV pseudoaneurysm with those of conservative treatment.MethodsFrom 2016 to 2021, 22 patients were hospitalized for LV pseudoaneurysm, including 17 cases (77.3%) caused by myocardial infarction. Of the 17 patients, 10 (58.8%) underwent surgical repair, while seven (41.2%) were treated medically. The clinical course, echocardiograph data, and surgical outcomes were analyzed. Survival rates of the surgical and conservative groups were compared.ResultsThere were no perioperative deaths. Intra-aortic balloon pumping support was required in two (20%) patients. No follow-up mortality was observed in the surgical group and at the last follow-up, all the patients were classified as New York Heart Association class I–II. In the conservative group, there was one (14.3%) hospital death and two (28.6%) additional deaths during follow-up. A significant difference was found in survival between the two groups (P = 0.024).ConclusionsSurgical repair of post-infarction LV pseudoaneurysm can be performed with good results, while conservative treatment carries a significant risk of sudden death. Surgical repair is indicated for every patient diagnosed, even those with a small pseudoaneurysm without symptoms.

Left Ventricular Pseudoaneurysm in an Adult With a Repaired Partial Atrioventricular Canal Defect

“…Zhong et al . 9 reviewed 17 cases of post–myocardial infarction LV pseudoaneurysms, 10 of which were managed surgically and the remainder medically. All patients who were treated surgically survived, with a mean follow-up duration of 18.5 months.…”

“…The overall survival was higher among the surgical group compared with the medically managed group (100% vs 57%, P = .02). 9 Medical therapy alone is associated with risk, but long-term survival has been described. In our patient, the surgical risk was believed to be prohibitive.…”

Traumatic right ventricular rupture: Case report and brief review of the literature

“…In left ventricular (LV) ruptures with pseudoaneurysm, surgical repair is superior to conservative management [22 , 23] . Additionally, the risk of stroke from an untreated LV pseudoaneurysm poses a significant risk from the accumulating thrombus [24] .…”

Case report: Spontaneous closure of ventricular pseudoaneurysm post-acute myocardial infarction with non-surgical therapy

“…According to previous literature ( Table 1 ), most patients accepted surgical therapy. The outcomes were diverse in different clinical centers, operation associated mortality ranged from 0 to 35.7% ( 1 – 3 , 5 – 11 ), mortality during follow-up ranged from 0 to 31% ( 1 – 6 , 8 – 11 ), and patients with acute pseudoaneurysm or high surgical risks had higher mortality ( 3 ). The mortality of conservative therapy was also discussed in some studies with a small sample size, which appeared to be higher than surgical therapy ( 1 , 4 , 5 , 7 , 11 ).…”

“…The outcomes were diverse in different clinical centers, operation associated mortality ranged from 0 to 35.7% ( 1 – 3 , 5 – 11 ), mortality during follow-up ranged from 0 to 31% ( 1 – 6 , 8 – 11 ), and patients with acute pseudoaneurysm or high surgical risks had higher mortality ( 3 ). The mortality of conservative therapy was also discussed in some studies with a small sample size, which appeared to be higher than surgical therapy ( 1 , 4 , 5 , 7 , 11 ). Meanwhile, some retrospective studies reported patients with chronic small (< 3 cm in size) LV pseudoaneurysm or patients with high surgical risks could be managed conservatively ( 12 ).…”