Surgical Treatment of Postinfarction Left Ventricular Pseudoaneurysms

Lafci, Banu; Özsöyler, İbrahim; Emrecan, Bilgin; Göktoğan, Tayfun; Bozok, Şahin; Yasa, Haydar; Karahan, Nagihan; Gürbüz, Ali

doi:10.1532/hsf98.20061042

Cited by 6 publications

(4 citation statements)

References 13 publications

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“…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 ).…”

Section: Discussionmentioning

confidence: 99%

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

Shuai

Wei

2022

Front. Cardiovasc. Med.

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Left ventricle (LV) pseudoaneurysm is a rare disorder post-acute myocardial infarction (AMI). Resection or closure of the pseudoaneurysm by surgery is recommended due to the high propensity of pseudoaneurysm rupture while surgery has also high risks. Conservative therapy could be acceptable in small pseudoaneurysms or patients with high surgical risks. Nevertheless, the risk evaluation and grasp of indication are not clear. This case reported an acute cyst-like LV pseudoaneurysm formation post-AMI-induced myocardial free wall rupture (MFWR), and the patient recovered with spontaneous closure of the fissure and shrinkage of the LV pseudoaneurysm through non-surgical therapy. Based on the observations in the echocardiogram, we proposed that intermittent closing of the fissure and interruption of the blood flow between the LV and the pseudoaneurysm due to LV contraction alleviated stress change on the pseudoaneurysm. The narrow fissure, small pseudoaneurysm, and intermittently interrupted blood flow that benefit fissure healing and pseudoaneurysm stabilization could indicate the prognosis of this patient. Drugs like β-blocker that decreased the stress on the pseudoaneurysm also led to the risk reduction of pseudoaneurysm rupture. To our knowledge, this is the first case that reports a spontaneous closure of LV pseudoaneurysm. The size of the fissure and the pseudoaneurysm, as well as the corresponding hemodynamic state, could be valuable to evaluate the risk and prognosis of the pseudoaneurysm. Optimized medical management was also helpful to pseudoaneurysm stabilization.

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Section: Discussionmentioning

confidence: 99%

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

Shuai

Wei

2022

Front. Cardiovasc. Med.

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“…15,16 Histopathological examination of excised ventricular wall after operation helps to confirm the diagnosis and evaluate diagnostic methods of the this disease. 12,17 In our series, all patients' aneurysmal tissue was investigated by pathology department and all of them were confirmed as a LV pseudoaneurysm.…”

Section: Discussionmentioning

confidence: 99%

“…Moreno et al 15 concluded that postoperative mortality after surgical repair of a LV pseudoaneurysm ranges from 13% to 29%. However, most clinicians consider this relatively high mortality acceptable because of the risk of fatal rupture 3,5,17 . The outcome of patients with this condition treated conservatively has been assumed to be poor, with a mortality of around 50% at two years 15 .…”

Section: Discussionmentioning

confidence: 99%

“…However, most clinicians consider this relatively high mortality acceptable because of the risk of fatal rupture. 3,5,17 The outcome of patients with this condition treated conservatively has been assumed to be poor, with a mortality of around 50% at two years. 15 Improvements in surgical technique may have decreased the perioperative mortality rate for most patients with LV psudoaneurysm to <10%; however, patients who also require a mitral valve surgery for severe mitral regurgitation, advanced age, and poor LV function have a much higher risk of death.…”

Section: Discussionmentioning

confidence: 99%

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Surgical Treatment of Postinfarction Pseudoaneurysms of the Left Ventricle

Narin¹,

Ege²,

Özkara³

et al. 2008

Journal of Cardiac Surgery

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

Prifti

Bonacchi

Baboci

et al. 2017

Annals of Medicine &Amp; Surgery

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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.

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Surgical Treatment of Postinfarction Left Ventricular Pseudoaneurysms

Cited by 6 publications

References 13 publications

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

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

Surgical Treatment of Postinfarction Pseudoaneurysms of the Left Ventricle

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

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