Takayasu’s arteritis with giant left ventricular pseudoaneurysm presenting as heart failure

Abstract

Takayasu’s arteritis (TA) is a vasculitis with a predilection for young women. Left ventricular pseudoaneurysm (PSA) in TA is a rare phenomenon. We report a 36 years old Filipina who presented with heart failure symptoms. Years prior, she had a recurrent fever, headache, myalgia and left arm claudication. On workup, a 2D echo revealed a left ventricular PSA with mural thrombus and moderate mitral regurgitation. Cardiac MRI further characterised the PSA with a sac diameter of 8×7.5×8.4 cm (CC×T×AP). Carotid Duplex Scan revealed total occlusion of the mid to distal right common carotid artery and left subclavian artery. She was started on immunosuppresants and guideline-directed medical therapy (GDMT) for heart failure and subsequently underwent successful endoventricular patch closure and mitral valve repair. This case highlights the importance of actively searching for cardiac complications of TA which although very rare, can dominate the clinical picture and may carry a dismal prognosis if left untreated.

Hypertrophic cardiomyopathy-related left ventricular pseudoaneurysm: A case report

“…The condition most frequently associated with LVP is transmural MI (55%), followed by cardiac surgery (33%), chest trauma (7%), and infection (5%) [ 1 ]. Other causes of LVP include catheter ablation procedures, Takayasu's arteritis, collagen disease, congenital heart disease, and idiopathic causes [ [4] , [5] , [6] , [7] , [8] ]. Early and accurate diagnosis remains challenging owing to the nonspecific signs and symptoms including chest pain, dyspnea, palpitations, and syncope.…”