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Naseerullah FS, Pyle W, Addai T, Murthy A. Left ventricular pseudoaneurysm without antecedent myocardial infarction. J Cardiol Cases 2023. [DOI: 10.1016/j.jccase.2023.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2023] Open
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Bakhutashvili Z, Janelidze L, Beria K, Bakashvili N, Kuridze N. Left ventricular pseudoaneurysmectomy in patient without hemodynamic instability: A case report. Clin Case Rep 2023; 11:e6855. [PMID: 36694640 PMCID: PMC9842869 DOI: 10.1002/ccr3.6855] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2022] [Revised: 01/02/2023] [Accepted: 01/04/2023] [Indexed: 01/18/2023] Open
Abstract
We present a case of a 66-year-old male with a history of two previous diagnoses of myocardial infarction, followed by drug-eluting stent implantation. During the check-up, he complained of dyspnea, fatigue, and dizziness. Echocardiography revealed a massive left ventricular pseudoaneurysm (LVP). According to the patient's clinical manifestations and radiologic data, urgent surgical intervention was performed. Postoperatively, several complications appeared, which were managed successfully. The patient was discharged in stable condition. This is an interesting case of massive LVP without hemodynamic instability.
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Affiliation(s)
- Zviad Bakhutashvili
- Department of Cardiac SurgeryG. Chapidze Emergency Cardiology CenterTbilisiGeorgia
| | - Lia Janelidze
- Department of Cardiac SurgeryG. Chapidze Emergency Cardiology CenterTbilisiGeorgia
| | - Kakhaber Beria
- Department of Cardiac SurgeryG. Chapidze Emergency Cardiology CenterTbilisiGeorgia
| | - Nana Bakashvili
- Department of Cardiac SurgeryG. Chapidze Emergency Cardiology CenterTbilisiGeorgia
| | - Nika Kuridze
- Department of Cardiac SurgeryG. Chapidze Emergency Cardiology CenterTbilisiGeorgia,Faculty of Clinical and Translational MedicineIvane Javakhishvili Tbilisi State UniversityTbilisiGeorgia
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Hang D, Iqbal Z, Gebrehiwot Y, Schena S, Joyce LD, Almassi GH, Pagel PS. Multilobular Structure Near the Left Ventricular Apex: Pericardial Effusion or a More Sinister Pathology? J Cardiothorac Vasc Anesth 2022; 36:3982-3985. [PMID: 35786349 DOI: 10.1053/j.jvca.2022.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Accepted: 06/01/2022] [Indexed: 11/11/2022]
Affiliation(s)
- Dustin Hang
- Department of Anesthesiology, Medical College of Wisconsin, Milwaukee, WI.
| | - Zafar Iqbal
- Anesthesia Service and the Cardiothoracic Surgery Service, Clement J. Zablocki Veterans Affairs Medical Center, Milwaukee, WI
| | - Yizez Gebrehiwot
- Department of Anesthesiology, Medical College of Wisconsin, Milwaukee, WI
| | - Stefano Schena
- Anesthesia Service and the Cardiothoracic Surgery Service, Clement J. Zablocki Veterans Affairs Medical Center, Milwaukee, WI; Division of Cardiothoracic Surgery, Medical College of Wisconsin, Milwaukee, WI
| | - Lyle D Joyce
- Division of Cardiothoracic Surgery, Medical College of Wisconsin, Milwaukee, WI
| | - G Hossein Almassi
- Anesthesia Service and the Cardiothoracic Surgery Service, Clement J. Zablocki Veterans Affairs Medical Center, Milwaukee, WI; Division of Cardiothoracic Surgery, Medical College of Wisconsin, Milwaukee, WI
| | - Paul S Pagel
- Anesthesia Service and the Cardiothoracic Surgery Service, Clement J. Zablocki Veterans Affairs Medical Center, Milwaukee, WI
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Pasala S, Pak K, Genovese L, Emaminia A. Left ventricular pseudoaneurysm in a young adult after non-ST elevation myocardial infarction. BMJ Case Rep 2022; 15:e244880. [PMID: 35351772 PMCID: PMC8966503 DOI: 10.1136/bcr-2021-244880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/02/2021] [Indexed: 11/04/2022] Open
Affiliation(s)
- Swetha Pasala
- Department of Internal Medicine, Inova Fairfax Hospital, Annandale, Virginia, USA
| | - Kevin Pak
- Department of Internal Medicine, Walter Reed National Military Medical Center, Bethesda, Maryland, USA
| | - Leonard Genovese
- Department of Cardiology, Inova Heart and Vascular Institute, Falls Church, Virginia, USA
| | - Abbas Emaminia
- Division of Cardiology, Inova Heart and Vascular Institute, Falls Church, Virginia, USA
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Cardiac Outpouchings: Definitions, Differential Diagnosis, and Therapeutic Approach. Cardiol Res Pract 2021; 2021:6792643. [PMID: 34567801 PMCID: PMC8463251 DOI: 10.1155/2021/6792643] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Accepted: 08/30/2021] [Indexed: 02/06/2023] Open
Abstract
Background and Aims Cardiac outpouchings encounter a series of distinct congenital or acquired entities (i.e. aneurysms, pseudoaneurysms, diverticula, and herniations), whose knowledge is still poorly widespread in clinical practice. This review aims to provide a comprehensive overview focusing on definition, differential diagnosis, and prognostic outcomes of cardiac outpouchings, as well as further insights on therapeutic options, in order to assist physicians in the most appropriate decision-making. Methods The material reviewed was obtained by the following search engines: MEDLINE (PubMed), EMBASE, Google Scholar, and Clinical Trials databases, from January 1966 until March 2021. We searched for the following keywords (in title and/or abstract): (“cardiac” OR “heart”) AND (“outpouching” OR “outpouch” OR “aneurysm” OR “pseudoaneurysm” OR “false aneurysm” OR “diverticulum” OR “herniation”). Review articles, original articles, case series, and case reports with literature review were included in our search. Data from patients with congenital or acquired cardiac outpouchings, from prenatal to geriatric age range, were investigated. Results Out of the 378 papers initially retrieved, 165 duplicates and 84 records in languages other than English were removed. Among the 129 remaining articles, 76 were included in our research material, on the basis of the following inclusion criteria: (a) papers pertaining to the research topic; (b) peer-reviewed articles; (c) using standardized diagnostic criteria; and (d) reporting raw prevalence data. Location, morphologic features, wall motion abnormalities, and tissue characterization were found to have a significant impact in recognition and differential diagnosis of cardiac outpouchings as well as to play a significant role in defining their natural history and prognostic outcomes. Conclusions Careful recognition of cardiac outpouchings remains a diagnostic challenge in clinical practice. Due to a broad cluster of distinctive and heterogeneous entities, their knowledge and timely recognition play a pivotal role in order to provide the most appropriate clinical management and therapeutic approach.
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Surgical Treatment of Chronic Giant Left Ventricular Pseudoaneurysm. Case Rep Cardiol 2021; 2021:4308690. [PMID: 33628516 PMCID: PMC7892212 DOI: 10.1155/2021/4308690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Revised: 12/20/2020] [Accepted: 01/31/2021] [Indexed: 11/29/2022] Open
Abstract
Left ventricle pseudoaneurysm is usually a severe complication of acute myocardial infarction, caused by rupture of the myocardial wall with pericardium bleeding. Mortality can reach 50 to 80% within a week if not properly treated. Hemodynamic instability, cardiac tamponade, and cardiac arrest are life-threatening presentations that require surgical treatment. We report a case of a man with a left ventricle chronic giant pseudoaneurysm and unspecific symptoms. After critical judgement on a heart team basis, surgical treatment was successfully performed, with a good long-term clinical outcome.
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Pseudoaneurysm Development after Free Wall Rupture Post Myocardial Infarction. J Cardiovasc Dev Dis 2020; 7:jcdd7030034. [PMID: 32906639 PMCID: PMC7570278 DOI: 10.3390/jcdd7030034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Revised: 08/28/2020] [Accepted: 08/31/2020] [Indexed: 11/19/2022] Open
Abstract
Background: According to the World Health Organization, cardiovascular disease is the number one cause of death globally, claiming millions of lives each year with an increasing prevalence. Myocardial infarction (MI) makes up a large sum of these deaths each year. While MI in itself is lethal, there are several complications that can increase the morbidity and mortality of an MI, such as left ventricular wall rupture and aneurysms. Case Presentation: We present a case of an elderly male with an extensive cardiac history who presented with a non-ST segment myocardial infarction (NSTEMI) managed with percutaneous coronary intervention. Hours after, he became hemodynamically unable and was found to have a pseudoaneurysm of the left ventricle. Despite aggressive efforts, his pseudoaneurysm ruptured and he ultimately succumbed to his condition. Conclusions: Left ventricular pseudoaneurysm is usually seen after myocardial infarctions with a rupture rate of up to 45% leading to a mortality rate of about 50%. While cardiac catheterization with left ventriculography is the gold standard for diagnosis, echocardiography can also be used as an alternative. Treatment is emergent cardiac surgery but still holds a high operative risk. Therefore, patients may be medically stabilized and managed prior to ultimate surgical intervention.
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Al-Naabi MJ, Maddali MM, Venkatachlam R. Mechanical Complication After a Myocardial Infarction. J Cardiothorac Vasc Anesth 2020; 35:670-672. [PMID: 32709384 DOI: 10.1053/j.jvca.2020.06.076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2020] [Revised: 06/22/2020] [Accepted: 06/24/2020] [Indexed: 11/11/2022]
Affiliation(s)
| | - Madan Mohan Maddali
- Department of Cardiac Anesthesia, National Heart Center, Royal Hospital, Muscat, Oman.
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Singh AS, Sivakumar K. Case report: pericardial adhesions from a previous coronary artery bypass surgery contain a left ventricular free wall rupture after an acute myocardial infarction to form a pseudoaneurysm. EUROPEAN HEART JOURNAL-CASE REPORTS 2019; 2:yty081. [PMID: 31020158 PMCID: PMC6177030 DOI: 10.1093/ehjcr/yty081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Accepted: 06/17/2018] [Indexed: 12/02/2022]
Abstract
Background Fatal mechanical complications of acute myocardial infarctions include free wall rupture and ventricular septal rupture. If pericardial adhesions wall off a free wall rupture, it may lead to formation of pseudoaneurysms that are characterized by a narrow mouth. Even though pseudoaneurysms are common after myocardial infarctions, they may also occur following surgery, trauma, and infections rarely. Case summary We present a case of a 62-year-old man who developed a left ventricular pseudoaneurysm 2 weeks after thrombolysis for an acute inferolateral myocardial infarction. Multiple non-invasive imaging modalities demonstrated the anatomy, regional and global ventricular function, distortion of mitral annulus by the eccentric large aneurysm. Pericardial scars after a previous coronary bypass surgery contained this left ventricular free wall rupture and helped in providing a safe window period for corrective surgery. Discussion While left ventricular pseudoaneurysms that develop following myocardial infarctions warrant emergency surgery due to the high impending chances of rupture and tamponade, previous surgical pericardial adhesions guarded against an imminent collapse. Multimodality imaging of the aneurysm helped in planning the surgical strategy.
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Affiliation(s)
- Arvind Sahadev Singh
- Department of Pediatric Cardiology, Institute of Cardiovascular Diseases, Madras Medical Mission, 4A, Dr J J Nagar, Mogappair, Chennai, India
| | - Kothandam Sivakumar
- Department of Pediatric Cardiology, Institute of Cardiovascular Diseases, Madras Medical Mission, 4A, Dr J J Nagar, Mogappair, Chennai, India
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Naseerullah FS, Baig M, Wool KJ, Murthy A. Left ventricle pseudoaneurysm: Diagnosis by a new murmur. J Cardiol Cases 2018; 18:20-24. [PMID: 30279903 DOI: 10.1016/j.jccase.2018.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2017] [Revised: 03/09/2018] [Accepted: 03/19/2018] [Indexed: 10/17/2022] Open
Abstract
Incomplete rupture of the ventricle free wall can occur after myocardial infarction. This occurs when an organized thrombus and the pericardium seal the ventricular perforation. This can progress to the formation of a left ventricle pseudoaneurysm (LVPA). A 70-year-old male with an antero-septal ST-elevation myocardial infarction (STEMI) underwent an emergent left heart catheterization which revealed severe three-vessel disease with occluded grafts, non-amenable to re-vascularization, and an apical thrombus. As he was high-risk for repeat coronary artery bypass graft, he was medically managed. Transthoracic echocardiogram (TTE) showed a normal left ventricle ejection fraction (LVEF), apical anterior and inferior wall akinesis, moderate sized apical thrombus, and pericardial thickening. On hospital day 7, examination revealed a new 3/6 to-and-fro murmur that was loudest at the apex. The patient was asymptomatic with normal vital signs. A repeat TTE revealed an apical wall rupture with flow into the pericardial cavity and absence of the apical thrombus. A LVPA was diagnosed and the patient was immediately referred for surgical repair. This case illustrates the potential for developing LVPA in STEMI patients and the importance of physical examination. If identified early a potential emergent situation in a previously asymptomatic patient can be averted, thereby preventing fatal consequences. <Learning objective: With the growing use of diagnostic testing the importance of physical examination is being lost. However, with an astute cardiac examination, potential complications such as a left ventricular pseudoaneurysm can be identified and promptly managed. In addition, a ventricular pseudoaneurysm must be considered in the differential as a rare complication in post ST-elevation myocardial infarction patients with a new murmur.>.
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Affiliation(s)
- Fahad S Naseerullah
- Department of Hospital Medicine, SSM Health Good Samaritan Hospital, 1 Good Samaritan Way, Mt. Vernon, IL 62864, USA
| | - Muhammad Baig
- Division of Hospital Medicine, Miriam Hospital, Providence, RI, USA
| | - Kenneth J Wool
- Department of Internal Medicine, UAB Montgomery Internal Medicine, Montgomery, AL, USA
| | - Avinash Murthy
- Department of Interventional Cardiology, Southern Illinois Heart and Vascular Center, Mt. Vernon, IL, USA
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Sui Y, Teng S, Qian J, Zhao Z, Zhang Q, Wu Y. Treatment outcomes and therapeutic evaluations of patients with left ventricular aneurysm. J Int Med Res 2018; 47:244-251. [PMID: 30270805 PMCID: PMC6384485 DOI: 10.1177/0300060518800127] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE This study was performed to analyze and compare the efficacy of three treatment methods for left ventricular aneurysm (LVA): coronary artery bypass grafting (CABG) combined with left ventricular resection, drug treatment, and percutaneous coronary intervention (PCI). METHODS In total, 183 patients with LVA from Fuwai Hospital were divided into three groups according to the treatment method: 51 patients underwent left ventricular resection combined with CABG (CABG-resection group), 65 underwent drug treatment (drug group), and 67 underwent PCI (PCI group). The clinical characteristics and survival rates of the patients were compared among the three groups. RESULTS The patients' basic data and medical history were analyzed. The postoperative left ventricular end-diastolic dimension (LVEDD) and left ventricular ejection fraction (LVEF) were significantly higher than those before surgery, indicating that the left ventricular function markedly improved after the operation. CONCLUSION Surgery is recommended as the first treatment option for LVA, and conservative therapy can be considered for selected patients. Although the difference was not statistically significant, CABG with left ventricular resection was associated with a better LVEF and LVEDD and higher survival and non-recurrence rates than PCI or drug treatment.
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Affiliation(s)
- Yonggang Sui
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, People's Republic of China
| | - Siyong Teng
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, People's Republic of China
| | - Jie Qian
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, People's Republic of China
| | - Zhenyan Zhao
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, People's Republic of China
| | - Qian Zhang
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, People's Republic of China
| | - Yongjian Wu
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, People's Republic of China
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Inayat F, Ghani AR, Riaz I, Ali NS, Sarwar U, Bonita R, Virk HUH. Left Ventricular Pseudoaneurysm: An Overview of Diagnosis and Management. J Investig Med High Impact Case Rep 2018; 6:2324709618792025. [PMID: 30090827 PMCID: PMC6077878 DOI: 10.1177/2324709618792025] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Accepted: 06/23/2018] [Indexed: 11/16/2022] Open
Abstract
Left ventricular pseudoaneurysm is a rare but life-threatening disorder that is frequently reported secondary to myocardial infarction or cardiac surgery. In this article, we chronicle the case of a patient with no prior risk factors who presented with a 2-week history of nonexertional atypical left chest pain. Apical 2-chamber transthoracic echocardiography revealed an unexpected outpouching of basal inferoseptal wall of the left ventricle, which had a narrow neck and relatively wide apex. The patient was diagnosed with left ventricular pseudoaneurysm and medical therapy was initiated. He refused to undergo the surgical intervention and subsequently, he was discharged from the hospital in stable condition. This article illustrates that physicians should be vigilant for atypical presentations of left ventricular pseudoaneurysm, and a high index of suspicion should be maintained for this stealth killer while performing appropriate diagnostic imaging. Additionally, we review the currently available approaches to diagnosis and management in these patients.
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Affiliation(s)
| | | | - Iqra Riaz
- Einstein Medical Center, Philadelphia, PA, USA
| | | | - Usman Sarwar
- Abington Hospital-Jefferson Health, Abington, PA, USA
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Garcia-Guimaraes M, Velasco-Garcia-de-Sierra C, Estevez-Cid F, Perez-Cebey L, Bouzas-Mosquera A, Mendez-Eirin E, Fernandez-Arias L, Cuenca-Castillo JJ, Vazquez-Rodriguez JM. Current role of cardiac imaging to guide surgical correction of a giant left ventricular pseudoaneurysm. Int J Cardiol 2015; 198:152-3. [PMID: 26186572 DOI: 10.1016/j.ijcard.2015.06.129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2015] [Accepted: 06/27/2015] [Indexed: 10/23/2022]
Affiliation(s)
| | | | - Francisco Estevez-Cid
- The Cardiac Surgery Department of Complejo Hospitalario Universitario de A Coruña, Spain
| | - Lucia Perez-Cebey
- The Cardiology Department of Complejo Hospitalario Universitario de A Coruña, Spain
| | | | | | - Laura Fernandez-Arias
- The Cardiac Surgery Department of Complejo Hospitalario Universitario de A Coruña, Spain
| | - J J Cuenca-Castillo
- The Cardiac Surgery Department of Complejo Hospitalario Universitario de A Coruña, Spain
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