Figure 1 - uploaded by Khaled Alfakih
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A. Cardiac MRI. Left ventricular outflow tract confirming pseudoaneurysm in the basal inferolateral segment. A, aorta; LA; left atrium; LV, left ventricle; PA, pseudoaneurysm. B. Late gadolinium enhancement of the left ventricular outflow tract confirming full thickness infarction in the basal inferolateral segment (white arrow) and in apex. Normal myocardium appears black.
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Citations
... Moreover, LVP occurring in the first days after AMI are those at highest risk of rupture. The risk of rupture is lower for chronic pseudoaneurysms (5,30,31). ...
... A left ventricular (LV) pseudoaneurysm is formed when a free myocardial wall rupture is contained by the surrounding pericardium and scar tissue [1]. A pseudoaneurysm differs from true aneurysms as it contains no myocardium or pericardium. ...
... LV pseudoaneurysms are very rare, with an incidence of 0.23% [2]. Myocardial infarction (MI) and surgeries are the most common etiologies, with the former accounting for 55% of the cases [1]. Common symptoms include dyspnea, chest pain, and congestive heart failure [3]. ...
In this report, we present a case of a 51-year-old male patient with a left ventricular (LV) pseudoaneurysm and a ruptured lateral wall due to a previous myocardial infarction. This patient was referred to the Coronary Care Unit with a past history of acute coronary syndrome of two months. He presented with palpitations and acute pulmonary edema upon admission. Color Doppler detected a ruptured lateral ventricular wall, and an echocardiogram confirmed the presence of a lateral ventricular wall pseudoaneurysm. Emergency LV aneurysmal rupture repair surgery was performed on this patient, and the postoperative findings were stable till discharge.
... The mortality rate is as high as 40% with complications such as rupture, cardiac tamponade, thromboembolism, and arrhythmia [5]. The risk of rupture is as high as 30-45% if left untreated [6]. The inferior or inferolateral walls are the most common site of LV PSA and the risk factors for its development are advanced age, female sex, hypertension, first MI, lack of collaterals, late presentation of MI, and delayed or no revascularization [3]. ...
... Moreover, LVP occurring in the first days after AMI are those at highest risk of rupture. The risk of rupture is lower for chronic pseudoaneurysms (5,30,31). ...
Left ventricular pseudoaneurysm (LVP) is a very rare, but potentially lethal mechanical complication of acute myocardial infarction (AMI). Despite representing a unique subset of cardiac rupture, it presents peculiar features that distinguish it from both ventricular free-wall rupture (FWR) and ventricular true aneurysm. LVP occurs in less than 0.5% of patients affected by AMI. However, LVP is generally burdened by high mortality, often related to false cavity rupture, leading to catastrophic and often irreversible consequences. The risk of rupture is inversely proportional to the timing from AMI onset, which also determines both the classification of LVP and drives the indication for treatment. Despite the lack of a current consensus on LVP management, urgent surgery is the treatment of choice for LVPs occurring within 3 months from AMI, especially if larger than 3 cm in diameter. A matter of debate, however, is represented by chronic LVPs, especially because the risk of rupture decreases progressively as time passes and left ventricular (LV) false cavity stabilizes. Surgical mortality rate remains not negligible (more than 20%), but these suboptimal results may be considered acceptable, especially considering the lethality associated with the occurrence of pseudoaneurysm rupture. Diagnostic workup is essential for anatomical characterization of LV rupture, which is mandatory to guide the decision on surgical approach and technique for pseudoaneurysm repair. Finally, for a subset of patients with anterior LVP and a well-defined fibrotic neck, and deemed at excessively high surgical risk, percutaneous closure of the cavity has been described with encouraging results.
... As more chronic cases are being diagnosed through advanced cardiac imaging techniques, more and more physicians choose to closely follow their patients without a need for urgent surgical intervention [1]. Unlike acute pseudoaneurysms that have higher tendency to rupture, conservative approach with optimizing heart failure treatment and consideration of anticoagulation could be an option in chronic cases who are deemed to be at high risk for intervention [2]. ...
... Untreated LV pseudoaneurysms are prone to rupture. The risk of rupture has been reported as high as 30% to 45%, although advances in imaging have increased the diagnosis of "incidental" pseudoaneurysms in asymptomatic patients, possibly reducing the risk for rupture(9). Surgery is the firstline treatment associated with significantly lower mortality compared with conservative therapy (23% vs. 48%). ...
This is a case of a chronic left ventricular pseudoaneurysm after inferior myocardial infarction that remained clinically silent for 5 years before presenting with sudden rupture, leading to hemopericardium and cardiac tamponade. We discuss the importance of surveillance for left ventricular pseudoaneurysms, the limitations of echocardiography, and the critical role of computed tomography angiography imaging to establish the diagnosis and guide therapy. (Level of Difficulty: Beginner.)
Pseudoaneurysm is a rare but lethal complication of acute myocardial infarction. In this study, we present a unique case of a patient with left ventricular free wall rupture detected by cardiac magnetic resonance more than 1 year after a percutaneous transluminal coronary intervention.
