Pseudoaneurysm of the Left Ventricle

Abstract: A case study is reported of a patient with rheumatoid arthritis who developed a pseudoaneurysm of the left ventricle after inferior myocardial infarction. The clinical diagnosis was confirmed by radionuclide cardiac blood pool imaging and by contrast ventricu-lography; the aneurysm was successfully excised.     

Real time observation of left ventricular aneurysm by B mode echocardiography.

This paper describes two cases of left ventricular aneurysm following myocardial infarction by real time B mode echocardiography with a mechanical sector scan. The most distinctive feature was the paradoxical movement of the aneurysmal wall; in systole, it moved posteriorly to form a bulge, whereas the remaining noinfarcted area was oriented toward the left ventricular cavity in contraction. The final diagnosis was verified by aneurysmectomy.     

Effects of coronary revascularization and concomitant aneurysmectomy on QT interval duration and dispersion

A reduction in QT dispersion (QTd) has been previously shown in patients receiving thrombolytics and undergoing coronary artery bypass grafting (CABG). The purpose of the present study was to investigate changes occurring in corrected QT intervals or QT dispersion after CABG and concomitant aneurysmectomy in the same session. The study population included 43 patients with coronary artery disease with left ventricular aneurysm (LVA). The control group included 32 patients with coronary artery disease without LVA. The study patients underwent CABG and aneurysmectomy in the same surgical session. Corrected maximum and minimum QT interval duration (QTcmax and QTcmin) and corrected QT dispersion (QTcd) were measured in the study patients before and after surgery. QTcmax and QTcd in the patients with LVA were significantly higher than in the patients without LVA (P < .001 and P < .001, respectively). QTcmax and QTcd in the patients with LVA were significantly shortened after surgery (P < .001 and P < .001, respectively). This study showed that QTcmax and QTcd values are significantly reduced after CABG and concomitant aneurysmectomy. We have suggested that coronary revascularization and left ventricular reconstruction in the same session have beneficial effects on QT interval duration and dispersion.     

左室重建术加冠状动脉旁路术治疗左室室壁瘤

目的：探讨穿壁性心肌梗塞的病人并发左室室壁瘤（ＬＶＡ）形成者手术指征，室壁瘤切除后左重建的手术技术及原理。方法：１９９８年３月至１９９９年７月，连续手术治疗１５例有典型心绞痛史的ＬＶＡ病人，左室和冠脉造影示１４例前间壁ＬＶＡ，１例为下壁室壁瘤伴二尖瓣关闭不全。左室附壁血栓９例，冠状口胸膜外游离左侧乳内动脉（ＬＩＭＡ）。前间壁ＬＶＡ，旁开左前降支动脉（ＬＡＤ）２．０ｃｍ平行切开ＬＶＡ。彻底清除左室内     

Left Atrial Appendage Aneurysm—A Rare Anomaly with an Atypical Presentation

Left atrial appendage aneurysm (LAAA) is a rare condition caused by congenital dysplasia of the atrial muscles. Patients usually present with atrial tachyarrhythmias as a result of ectopic foci of atrial rhythm generation or systemic thromboembolism. We report a case of a 38‐year‐old Native American female presenting with 1‐month history of cough, in sinus rhythm, and found to have a large cyst‐like structure next to the left ventricular lateral wall on transthoracic echocardiography. This structure was later confirmed as a LAAA on cardiac magnetic resonance imaging. Patient underwent aneurysmectomy without any complications.     

超声心动图对室壁瘤切除术后左心功能的初步研究

１１例患者于室壁瘤切除术前后进行了超声心动图检查。其中男１０例，女１例，年龄３９至６８岁。心尖部室壁瘤９例，下后壁室壁瘤２例。１０例患者室壁瘤切除术（ＬＶＡ）的同时进行了ＣＡＢＧ。ＥＤＶ、ＥＤＶＩ、ＥＳＶ、ＥＳＶＩ和ＳＶ于ＬＶＡ后明显减少（Ｐ＜０．０５－０．００１），ＨＲ增加，ＥＦ、ＣＯ和ＣＩ无明显变化。二尖瓣血流频谱显示所有患者舒张功能类型和Ｅ峰流速、Ｅ峰压差、Ａ峰流速、Ａ峰压差及ＩＶＲＴ手术前后均没有明显改变（Ｐ＞０．０５）。所以，ＬＶＡ可明显减低室壁瘤患者的ＥＤＶ、ＥＤＶＩ、ＥＳＶ、ＥＳＶＩ，使上述指标趋于正常；ＳＶ可出现下降但ＥＦ、ＣＯ和ＣＩ无变化。二尖瓣血流频谱的变化显示ＬＶＡ对左室舒张功能无明显影响。上述结论还有待进一步证实。     

Improved selection of patients for aneurysmectomy by combined phase and amplitude analysis of gated cardiac scintigraphy

Twelve patients undergoing left ventricular aneurysmectomy werestudied by combined phase and amplitude analysis of gated bloodpool scintigraphy before and after operation, to establish whetherthe presence of paradoxical systolic movement, as defined bythis method, influenced the result of surgical treatment. There was a significant increase in the ejection fraction afteroperation in those patients with paradoxical systolic movementand no improvement in those with akinesis. The extent of theincrease in ejection fraction was related to the size of paradoxicalsegment resected. It is argued that this improvement in leftventricular function reflects a reduction in the left ventricularend diastolic volume and improved efficiency of ejection ofthe stroke volume, resulting from resection of the scar. Combined phase and amplitude analysis may help in selectingpatients most likely to benefit from aneurysmectomy     

冠状动脉旁路移植术及室壁瘤切除术

本文报道冠状动脉旁路移植术和室壁瘤切除术５１例。全组中３４例为不稳定心绞痛，２５例多支病变，５例左主干狭窄，２４例陈旧性心肌梗死，１０例合并高血压，左室射血分数０．１４～０．７９，小于０．３者６例。均在常规体外循环和心脏停搏下手术，共架血管桥１０１支。全组１０例同期作了室壁瘤切除术，后者还同时修补室间隔穿孔和间隔瘤各１例。附加手术有心脏瓣膜替换术，冠状动脉内膜切除术和激光心肌再血管化各４例，术中冠脉腔内成形术２例及三尖瓣成形术１例。手术死亡７例，均与术前高危因素及左室功能差有关。随访６～１０８个月，３１例心绞痛消失，４例偶有轻度心绞痛，７例仍有劳力性心绞痛；晚期死亡２例，分别死于重症乙型肝炎和心律失常。重点讨论了手术病例选择，冠状动脉内膜切除术，室壁瘤切除修复术以及架桥与换瓣同期手术问题。