Surgical treatment of post-infarction left ventricular pseudoaneurysm: Case series highlighting various surgical strategies

Abstract

Introduction and objectiveThe left ventricular pseudoaneurysm (LVP) is rare, the surgical experience is limited and its surgical treatment remains still a challenge with an elevated mortality. Herein, it is presented a retrospective analysis of our experience with acquired post infarct LVP over a10-year period.Materials and methodsBetween January 2006 through August 2016, a total of 13 patients underwent operation for post infarct pseudoaneurysm of the left ventricle. There were 10 men and 3 women and the mean age was 61 ± 7.6 years. 4 patients presented acute LVP. Two patients had preoperative intraortic balloon pump implantation.ResultsVarious surgical techniques were used to obliterate the pseudoaneurysm such as direct pledgeted sutures buttressed by polytetrafluoroethylene felt, a Gore-Tex or Dacron patch, transatrial closure of LVP neck in submitral pseudoaneurysm, or linear closure in cases presenting associated postinfarct ventricular septal defect. Concomitant coronary artery bypasses were performed for significant stenoses in 12 patients, ventricular septal defect closure in 4 patients, mitral valve replacement in 3 and aortic valve replacement in 1 patient. Operative mortality was 30.8% (4 patients). Three of them were acute LVP. Three patients required the continuous hemodyalisis and 8 patients required intra-aortic balloon pump. At follow-up two deaths occurred at 1 and 3 years after surgery.ConclusionIn conclusion, this study revealed that surgical repair of post infarct left ventricular pseudoaneurysm was associated with an acceptable surgical mortality rate, that cardiac rupture did not occur in surgically treated patients.

Challenges in management of a giant left ventricular pseudoaneurysm complicated by intracerebral hemorrhage

“…2 Approximately 30% of LV pseudoaneurysms are ruptured upon diagnosis, and 30% to 45% result in rupture if untreated. 2 Thus, urgent surgery is generally indicated especially for large or expanding lesions, 1 as was in this case.…”

Exclusion of a submitral pseudoaneurysm by a conservative transmitral approa—Surgical technique for an unusual disease

“…5 Several surgical techniques to treat cardiac pseudoaneurysms are described, depending on its localization and the quality of the perianeurysmal cardiac tissue. 3,6,7 Submitral position, close to the circumflex artery, increased the risk of myocardial infarction on F I G U R E 1 Anatomical considerations of the submitral pseudoaneurysm. Computed tomography (A) and 3D-reconstruction (B) showed the orifice (*) of the pseudoaneurysm (PsA) just behind the mitral annulus (MA).…”

Repair of Enlarging Left Ventricular Pseudoaneurysm Two Months After Coronary Artery Bypass Grafting

“…In this case, we believed that a left thoracotomy afforded safe entry into a hostile chest and excellent exposure. Our approach avoided risk to patent grafts, thus preventing a known complication with repair through the anterior approach [3]. Additional challenges in this patient included extremely calcified femoral arteries, presence of fistulas in her upper extremities, and aortic insufficiency.…”

“…Management of ventricular pseudoaneuryms remains a surgical challenge, with reported in-hospital mortality rates from 20% to 35% [1- 3,5]. The timing and the surgical approach for LV pseudoaneurysms can be problematic.…”

“…Surgical repair is advocated given the risk of rupture, particularly in the acute setting. Reports advocate repair through midline sternotomy with cardiopulmonary bypass [1][2][3]. We present a challenging patient with a rapidly enlarging LV pseudoaneurysm 4 weeks after coronary bypass grafting (CABG).…”