False aneurysm of the right atrium.

A false aneurysm of the right atrium is described. The false aneurysm appeared after open-heart surgery and was probably related to loosening of a right atrial suture. Because of the low pressure in the right atrium, the danger of rupture seemed to be low, and conservative therapy was chosen.     

Faux anévrisme de la voie d’éjection du ventricule droit compliquant une endocardite infectieuse après réparation d’une cardiopathie congénitale

A case of an enormous false aneurysm of the right ventricular outflow tract due to infective endocarditis is reported in a 12-year old girl who underwent Rastelli repair of congenital heart disease with reconstruction of the right ventricular outflow tract by bovine jugular vein graft (Contegra). The false aneurysm was associated to desinsertion of the patch of the ventricular septal defect and compresses the right ventricle leading to heart failure and shock. Surgical treatment was performed in emergency but the child died after surgery. Infectious false aneurysm of the right ventricle after surgical reconstruction of the right ventricular outflow tract is very rare. At our knowledge, only three cases have been reported in the literature. We report here another case.     

False aneurysm of the right ventricular outflow tract after total correction of tetralogy of Fallot: diagnosis by echocardiography and successful repair by neck cannulation for cardiopulmonary bypass.

A case of false aneurysm related to the left side of the heart with a connection to the right ventricular outflow tract was found by echocardiography after complete repair of tetralogy of Fallot. Cardiopulmonary bypass was established by cannulating the right internal jugular vein and the ipsilateral common carotid artery. The aneurysm was then excised and the right ventricular outflow tract reconstructed by direct sutures.     

False aneurysm formation after ventricular rupture associated with reinfarction following successful thrombolysis

Summary A 69-year-old woman underwent successful thrombolysis for total occlusion in the right coronary artery using urokinase. One week later, the patient developed reinfarction in the area supplied by the right coronary artery, followed by ventricular rupture. She was resuscitated with drainage of the pericardial effusion. Cardiac catheterization confirmed that the site of the right coronary artery reocclusion was identical to that in the acute phase. A false aneurysm developed over the true aneurysm located in the inferior portion of the left ventricle as demonstrated by a ventriculogram at the convalescent stage and at surgery. The orifice of the false aneurysm has closed by suture.     

False aneurysm secondary to aortic cannulation--rupture into lung with fatal hemoptysis during aortography

We report a case of fatal rupture of a false aneurysm of the ascending aorta during aortographic injection. The aneurysm had formed at the site of aortic cannulation done for a cardiac bypass at an earlier date. The rupture manifested as hemoptysis as the false aneurysm had burrowed and ruptured into the anterior segment of the right upper lobe of the lung.     

False aneurysm of the right internal mammary artery.

False aneurysms of the internal mammary artery are extremely rare. A case of false aneurysm of a branch of the right internal mammary artery after median sternotomy is reported. A large right-sided mediastinal mass was seen on the thoracic radiogram. A false aneurysm was suspected on CT-scan and confirmed by angiography. In the same setting percutaneous embolization was performed.     

Myocardial infarction and biventricular free-wall rupture with shunting through a false aneurysm

A 65-year-old man presented with acute inferior myocardial infarction and received thrombolytic therapy with clinical evidence of coronary arterial recanalisation. Recovery was uncomplicated until- the eighth day when he experienced recurrent chest pain with evidence of reinfarction in the same territory. This was associated with the development of a pansystolic murmur and cardiogenic shock. Cardiac catheterisation showed right coronary arterial occlusion and inferior infarction with a false aneurysm and a left-to-right shunt (shunt ratio 2.5:1). Surgery confirmed the formation of a false aneurysm caused by rupture of the free walls of both ventricles. Importantly, however, the interventricular septum was intact and the left-to-right shunt was through the false aneurysm itself. This is the first report of biventricular free-wall rupture with shunting through a false aneurysm treated successfully by surgery.     

Spontaneous rupture of a coronary artery with false aneurysm formation. Successful surgical repair.

A patient with diffuse atherosclerotic coronary arterial disease was demonstrated to have a spontaneous rupture of the proximal right coronary artery, with formation of a false aneurysm. This was recognized at angiographic study, and the patient subsequently underwent a revascularization operation with suture ligation of the aneurysm.     

False aneurysm of the pulmonary artery associated with cardiac catheterisation.

A false aneurysm of the pulmonary artery developed in a 59 year old woman as a complication of right-sided cardiac catheterisation. This rare, life-threatening condition was successfully treated with coil embolisation of the feeding artery. Cardiologists and intensive care doctors should be aware of the possibility of the formation of false aneurysms of the pulmonary artery after Swan-Ganz and other right heart catheterisation. Appropriate therapy could be life-saving.     

Echography in aneurysm of the interatrial septum

Atrial septal aneurysm can be detected by subcostal echocardiography as a bulge of the intermediate interatrial septum, ballooning toward the right atrium. We retrospectively revised 5412 echo examinations, consecutively performed in our laboratory, and we found 14 cases of atrial septal aneurysm (0.26%), mean age 36 +/- 15 years, 9 males and 5 females. In 7 patients atrial septal aneurysm was wide, including the whole atrial septum; in 5, only cranial two-thirds of the septum were involved and in 2, it regarded only the intermediate septum. No patients referred to arrhythmias, syncope, embolism, endocarditis or transient ischemic neurologic disorders. Cardiac abnormalities or defects were associated to atrial septal aneurysm in 12/14 patients: they consisted of atrial septal defect, mitral valve prolapse, false ventricular tendons or persistent Chiari network. Atrial left-to-right shunt was detected in all 6 cases with atrial communication. Considering each single associated cardiac abnormality, the prevalence of atrial septal aneurysm was 7% in patients with atrial septal defect, 1.7% in those with mitral valve prolapse, 6.6% in persistent Chiari network and 0.9% in false ventricular tendons. In conclusion, echocardiography is the first-choice technique to detect atrial septal aneurysm and other related cardiac defects.     

Involvement of peripheral arteries in Von Recklinghausen neurofibromatosis

Arterial lesions are relatively rare in neurofibromatosis type?I but can have potentially serious consequences for the patient. We report two clinical cases of peripheral arterial involvement in neurofibromatosis type?1. The first case was a 25-year-old female with Von Recklinghausen disease who developed a swollen tender mass around her left arm. The arterial CT scan revealed a false aneurysm of the brachial artery. The surgical procedure involved repair of the false aneurysm, and ligation of the brachial artery. Intra- and postoperative bleeding was severe, leading to hemodynamic instability and impaired hemostasis. The patient died on day 2, postoperatively. The second case involved a 17-year-old male with Von Recklinghausen disease who presented stage?II arteritis of the right lower limb. Arteriography revealed a long stenosis of the right superficial femoral artery extending to the popliteal artery and an important collateral circulation in the leg arteries. Medical treatment with regular clinical supervision was recommended in this patient.     

Systolic compression of the right coronary artery by a pseudoaneurysm following mitral valve replacement

A patient who developed a pseudo-, or false, aneurysm following mitral valve replacement is presented here with the unique angiographic finding of systolic compression of the right coronary artery by the pseudoaneurysm. Clinical and angiographic features of this case along with a discussion of pseudoaneurysms and the significance and causes of systolic compression of coronary arteries are presented.     

Diagnosis and treatment of left ventricular false aneurysm.

Three patients are presented in whom a false aneurysm of the left ventricle was surgically treated. False aneurysm of the left ventricle is an unusual consequence of ventricular wall rupture with containment of the resulting hematoma. Most false aneurysms of the left ventricle develop following myocardial infarction. The false aneurysm wall contains no myocardium. The false aneurysm has a great tendency to rupture, regardless of its size. One patient developed progressive congestive heart failure following a myocardial infarction. The other two patients were asymptomatic following myocardial infarction. Preoperative magnetic resonance imaging showed characteristics of a false aneurysm. These included a distinct discontinuance of the myocardium at the neck of the aneurysm and a narrow neck relative to the diameter of the aneurysm. Two patients underwent successful closure of the orifice of the false aneurysms. One patient underwent emergency surgery because of acute rupture while awaiting surgery but died of cerebral damage. Surgical correction of a false aneurysm is clearly advisable even in the absence of symptoms.     

Echocardiographic findings of posterior wall false aneurysm: case report and review of the literature.

A case of angiographically proven posterolateral left ventricular false aneurysm is presented. The patient underwent successful surgery. The echocardiogram revealed large echo-free spaces behind the posterior wall of the left ventricle, delineated by pericardial echoes and lined internally by extra echoes. These echocardiographic findings are consistent with false aneurysm containing a clot. This report indicates that in patients with previous infarction and distorted cardiac silhouette, echo-cardiography may be helpful in the diagnosis of true or false ventricular aneurysm.     

Right arm ischemia following intentional stent-graft coverage of an anomalous right subclavian artery.

PURPOSE: To report thoracic aortic stent-graft repair in a patient with abnormal aortic arch anatomy. CASE REPORT: An anomalous right subclavian artery was covered with a stent-graft in a 38-year-old woman being treated for a false aneurysm after coarctation repair. The right arm became relatively ischemic, but was viable and managed conservatively. CONCLUSIONS: Aneurysms close to left or aberrant right subclavian arteries can be safely and effectively treated by endoluminal repair without the need for revascularization procedures; ischemic symptoms that develop are often mild and transient.     

A Giant Pseudoaneurysm of the Gluteal Artery

Aneurysms of the gluteal artery, true or false, are rare and usually follow pelvic fractures or penetrating trauma. We report on a case of a 77-year-old woman who developed a 16 cm large right gluteal aneurysm. Doppler ultrasound, CT scan and angiography confirmed the clinical diagnosis. The patient was successfully treated with endoaneurysmorrhaphy, after temporary clamping of the hypogastric artery using an extraperitoneal approach. In cases of very large gluteal aneurysms we believe that open surgical treatment is still preferable to endovascular procedures.     

Fortuitous discovery of the association of true and false aneurysm of the left ventricle after cardiogenic shock]

The authors report the fortuitous diagnosis of a true and a false left ventricular aneurysm in a 77 year old man with severe ischaemic heart disease and calcific aortic stenosis, admitted for cardiogenic shock. The association of these two forms of aneurysm is very rare. Clinical and paraclinical diagnosis is difficult. Conventional left ventriculography is the investigation of reference but the diagnosis has been facilitated by Technetium 99 cardiac scintigraphy and color Doppler echocardiography. Surgery may be considered in cases of true aneurysm especially in patients with left ventricular failure, but the indication is formal in cases of false aneurysm.     

False aneurysm formation following cutting balloon angioplasty in the renal artery of a child.

PURPOSE: To report the fortuitous discovery of a false aneurysm 7 years after cutting balloon angioplasty for severe renal artery fibromuscular dysplasia in a child. CASE REPORT: A 3-year-old girl with neurofibromatosis was referred to our institution because of high blood pressure (220/160 mmHg). Computed tomography identified coarctation of the aorta and severe bilateral renal artery stenoses. The coarctation was successfully resected. One month later, bilateral renal artery angioplasty with a 3-mm balloon was unsatisfactory, so a second angioplasty one month later was done with a 3.25-mm cutting balloon. This procedure was complicated by a minimal arterial rupture, which resolved spontaneously after inflation of a regular balloon. Normal blood pressure was restored. The child was lost to follow-up until 7 years later, when recurrent hypertension (200 mmHg systolic) prompted referral again. Arteriography showed a very severe stenosis on the right side and a 30-mm false aneurysm of the left renal artery at the rupture site. Due to her age, the patient underwent surgery, which brought the blood pressure under control. CONCLUSIONS: False aneurysm of the renal arteries is a rare complication of percutaneous angioplasty. In a child, the cutting balloon would appear to be contraindicated for concentric dysplastic stenoses that are resistant to regular balloon angioplasty.     

True and false aneurysms of the left ventricle following myocardial infarction

Anterolateral myocardial infarction resulted in the formation of both true and false aneurysms in a 75 year old man in whom severe congestive heart failure subsequently developed as the false aneurysm became progressively larger. Left ventriculography detected and quantified both aneurysms, and demonstrated reasonable function of the remaining volume-overloaded left ventricle. Resection of both aneurysms was accomplished with marked relief of symptoms. The literature on false aneurysm is reviewed, and the dilemma posed by the need to recognize false aneurysms before they become symptomatic or rupture is discussed.     

Diagnosis of pseudoaneurysm of the ascending aorta by pulsed Doppler cross sectional echocardiography

Pseudoaneurysms of the ascending aorta are relatively uncommon compared with those evolving from the left ventricle. In a young man with endocarditis of the aortic valve who developed a pseudoaneurysm arising from the ascending aorta, the diagnosis was established with the pulsed Doppler technique and cross sectional echocardiography by passing the Doppler sample from the aorta through the neck of the false aneurysm into the large pseudoaneurysm. Aortic root angiography showed this connexion to be a small fistula between the aorta and right atrium. Necropsy findings confirmed the diagnosis.