Ventricular pseudo-false aneurysm after myocardial infarction; report of a case

A 72-year-old man was admitted to our hospital with chest discomfort and syncope. The echocardiography showed the left ventricular aneurysm. The coronary arteriography revealed a complete occlusion at distal portion of the right coronary artery and anterior aneurysm of the left ventricle was demonstrated. We diagnosed that it was false aneurysm because of communicating with the left ventricle through a small orifice. Surgical repair was carried out after resection of the aneurysm of the left ventricle. The postoperative course was uneventful and discharged on the 33rd day after surgery. Pseudo-false ventricular aneurysm of the left ventricle was diagnosed by histological examination.     

Giant left ventricular pseudo-false aneurysm following myocardial infarction

We report a successful surgical ease of giant left ventricular pseudo-false aneurysm in a 63-year-old man. The abnormality of the inferior wall of the left ventricle was discovered incidentally by abdominal ultrasonography for health examination at another hospital. Transthoracic echocardiography and left ventriculography revealed a giant false aneurysm (74×75×40 mm) in the inferior wall of the left ventricle with a large orifice (70×58 mm). Repair of the aneurysm was performed under arrested heart, closing the large orifice with a Hemashield patch. Postoperative pathological examination proved that the wall of the aneurysm had myocardial tissue. The microscopic results strongly suggested that this aneurysm was a pseudo-false aneurysm.     

Rapidly enlarging giant left ventricular pseudo-false aneurysm after myocardial infarction; report of a case

A 71-year-old man was admitted to our hospital with acute myocardial infarction and cardiac tamponade. After pericardial drainage, his hemodynamics was improved. Because more than 3 days had been passed after the onset of myocardial infarction and he had severe renal dysfunction, emergent coronary angiography (CAG) was not performed. After improvement of his general status, coronary angiography and percutaneous catheter intervention was carried out, and his course was uneventful. But transthoracic echocardiography before discharge revealed a giant posterior psudoaneurysm. Patch closure and coronary artery bypass grafting was carried out under cardiopulmonary bypass, and postoperative course was uneventful. Postoperative left ventriculogram revealed disappearance of pseudoaneurysm, but relatively large akinetic area of posterior-inferior wall was left around a patch. Pseudo-false aneurysm was diagnosed by histological examination.     

冠心病并发左室室壁瘤的心室壁重建

目的探讨冠心病患者心肌梗死后并发左室室壁瘤的心室壁重建方法及疗效。方法 2003年6月-2008年8月,收治冠心病心肌梗死后并发左室室壁瘤患者23例。其中男13例,女10例;年龄47～74岁,平均61.2岁。心功能根据纽约心脏病协会(NYHA)分级标准:Ⅰ级3例,Ⅱ级6例,Ⅲ级10例,Ⅳ级4例。冠状动脉造影示冠状动脉单支病变2例,2支5例,3支16例。部位:心尖部18例,前壁合并外侧壁4例,单纯下壁1例。左室射血分数为36.52%±12.15%,左室舒张期末内径为(62.30±6.52)mm。术中直接行标准线性修补术9例,心内膜环缩后线性修补术6例,心内膜环缩后补片修补术8例。结果围手术期死亡2例,二次开胸止血1例;其余患者切口均Ⅰ期愈合,无早期相关并发症发生。术后21例存活患者均获随访,随访时间7～48个月,中位随访时间19个月。术后6个月,患者左室射血分数为46.52%±9.41%,较术前明显改善(t=2.240,P=0.023);左室舒张期末内径为(52.23±5.11)mm,较术前显著减小(t=2.170,P=0.035)。6个月时患者心功能根据NYHA分级标准:Ⅰ级8例,Ⅱ级13例。1例患者于术后18个月因脑出血死亡,其余患者均恢复日常生活。结论对冠心病并发左室室壁瘤患者,应根据不同病情采取个体化治疗,选择合适的瘤切除及心室壁重建方法,同期处理合并二尖瓣关闭不全和行冠状动脉旁路移植术,可取得良好效果。     

Left ventricular aneurysm after myocardial contusion caused by blunt chest trauma

A 30-year old male car-driver was polytraumatized after a frontal collision with another motor vehicle (left-sided rib fractures, right-sided pneumothorax, multiple lung contusions, anterior and posterior pelvic ring fracture, femoral shaft fracture, traumatic subarachnoid hemorrhage. After intubation and hemodynamic stabilization on the scene of accident, he was transported to our institution. Transesophageal echocardiography revealed a left-ventricular anteroseptal akinesia and patchy intramyocardial hyperdensities as indicator of myocardial contusion which was confirmed later by autopsy. In the further course, the patient developed an anteroseptal aneurysm with severe left ventricular dysfunction nad episodes of arrhythmias. Finally, septic shock complicated the case and the patient died 30 days of intensive care from therapy-refractory multiple organ system failure.     

Repair of a subepicardial aneurysm after myocardial infarction in a patient with congestive heart failure

Subepicardial aneurysm of the left ventricle is a rare complication of myocardial infarction. We report a case of a 75-year-old woman found to have a subepicardial aneurysm 4 months after an acute myocardial infarction. The patient was admitted to our hospital with congestive heart failure, and transthoracic echocardiography and left ventriculography showed an aneurysm on the posterior wall of the left ventricle, 4.6 x 3.5 cm in size. We performed patch repair using a Hemashield graft, with coronary artery bypass grafting. She was discharged on postoperative day 69, and has been well since.     

Left ventricular aneurysm

Left ventricular aneurysm in African patients is most often luetic; the only other common left ventricular aneurysm in African patients is agnogenic and not a complication of coronary artery disease. The management of a left ventricular aneurysm by surgical excision with cardiorespiratory bypass in an African patient is described. The literature which relates to left ventricular aneurysm in African patients is briefly reviewed.     

Repair of ventricular septal defect and left ventricular aneurysm following myocardial infarction

A successful simultaneous surgical repair of rupture of the interventricular septum and left ventricular aneurysm resulting from myocardial infarction is described. Very few similar cases have been described in the literature and in none was angiocardiography performed before operation. Preoperative angiocardiographic examination to demonstrate a ventricular aneurysm is of major importance in all cases of rupture of the interventricular septum following myocardial infarction. The right heart approach with injection of contrast material into the main pulmonary artery is shown to be the method of choice for this purpose.     

Dissecting aneurysm of ventricular septum following acute inferior myocardial infarction

Dissecting aneurysm of the ventricular septum as a complication after myocardial infarction (MI) is very rare. The patient was a 70-year-old women who was diagnosed with acute inferior MI. Three months after MI, catheterization showed a left ventricular aneurysm of the inferior wall, and left-to-right ventricular shunt flow was detected in the aneurysm. Echocardiography showed that the inferior left ventricular free wall was aneurysmal and dissected from the septal wall. Nine months after MI, chronic heart failure was uncontrollable by medication. At surgery, a tear (5 mm long) in the dissecting aneurysm of the ventricular septum was found and closed directly using 2 felt patches, and aneurysmectomy was performed using felt strips. The postoperative course was uneventful and she has been free from any complication for over 1 year.     

Three-dimension structure of ventricular myocardial fibers after myocardial infarction

Background  

To explore the pathological changes of three-dimension structure of ventricular myocardial fibers after anterior myocardial infarction in dog heart.     

Left ventricular performance before and after left ventriculotomy and removal of a left ventricular aneurysm

The effects of left ventriculotomy on left ventricular performance were studied in seven patients with ventricular tachyarrhythmia (VT) and nine patients with left ventricular aneurysm (LVA). Hemodynamic and left ventriculographic findings were evaluated before and after operations. In VT the non-contracting areas, measured at end-diastole, as mean 10.8 +/- 7.1% of the left ventricular internal surface area. There was no significant fall in left ventricular ejection fractions (EF), cardiac indexes (CI) and left ventricular end-diastolic volume indexes (LVEDVI) after left ventriculotomy. In LVA, the non-contracting areas decreased from 31.0 +/- 7.4% to 13.7 +/- 13.5% (p less than 0.01) in association with a reflex decrease in LVEDVI from 117 +/- 31.8 ml/m2 to 90.4 +/- 24.7 ml/m2 (p less than 0.05). EF increased from 40.8 +/- 7.00% to 54.6 +/- 10.7% (p less than 0.01). There was no significant change in CI and left ventricular stroke volume index after left ventricular aneurysmectomy. The observations indicate that left ventriculotomy of limited size is an acceptable and a safety approach to the ventricular tachyarrhythmias and another cardiac operations.     

Left ventricular assist device bridge therapy for acute myocardial infarction

BACKGROUND: Patients with acute myocardial infarction (AMI) complicated by cardiogenic shock have a high mortality rate. Current treatment modalities remain suboptimal for these patients. METHODS: From April 1995 to March 1998, 7 patients were identified as having AMI associated with cardiogenic shock. All received intraaortic balloon pump assistance, in addition to maximal inotropic support. RESULTS: The mean preoperative cardiac index was 2.0+/-0.3 L/min/m2 and pulmonary capillary wedge pressure was 23+/-6 mm Hg. Three patients received thrombolytic therapy and 4 patients underwent percutaneous transluminal coronary angioplasty without success. Left ventricular assist devices (LVADs) were implanted as bridge therapy to heart transplantation. One patient died from recurrence of a ventricular septal defect during LVAD support. Six patients were transplanted successfully after mean LVAD support of 59+/-33 days. Five patients are alive and well at a mean follow-up of 898+/-447 days. One patient died 3 days after transplantation from acute allograft dysfunction. CONCLUSIONS: Timely application of LVADs as bridge therapy to heart transplantation in these critically ill patients can be lifesaving, and should be investigated further.