Post-myocardial infarction left ventricular pseudoaneurysm diagnosed incidentally by echocardiography
A 54-year-old male developed a left ventricular pseudoaneurysm (Ps) along the lateral wall of the left ventricle (LV), which was diagnosed incidentally by two-dimensional transthoracic echocardiography (2DTTE) 6 months after an acute myocardial infarction. Color flow imaging (CFI) showed blood flow...
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| Format: | Article |
| Language: | English |
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BMC
2017-10-01
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| Series: | Echo Research and Practice |
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| Online Access: | http://www.echorespract.com/content/4/4/K37.full |
| _version_ | 1828264642045018112 |
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| author | Rienzi Díaz-Navarro Petros Nihoyannopoulos |
| author_facet | Rienzi Díaz-Navarro Petros Nihoyannopoulos |
| author_sort | Rienzi Díaz-Navarro |
| collection | DOAJ |
| description | A 54-year-old male developed a left ventricular pseudoaneurysm (Ps) along the lateral wall of the left ventricle (LV), which was diagnosed incidentally by two-dimensional transthoracic echocardiography (2DTTE) 6 months after an acute myocardial infarction. Color flow imaging (CFI) showed blood flow from the LV into the aneurysmal cavity and invasive coronary angiography revealed sub-occlusion of the circumflex artery. A complementary study using cardiovascular magnetic resonance (CMR) confirmed a dilated left ventricle with depressed ejection fraction, thin dyskinetic anterolateral and inferolateral walls, a Ps adjacent to the lateral wall of the LV contained by the pericardium and blood passing in and out through a small defect in the LV mid-anterolateral wall. Late gadolinium-enhanced imaging demonstrated transmural myocardial infarction in the lateral wall and delayed enhancement of the pericardium, which formed the walls of the Ps. A conservative approach was adopted in this case, optimizing the patient’s heart failure medications, including cardioselective beta-blocker agents, angiotensin-converting enzyme inhibitors, spironolactone and chronic anticoagulation therapy because of a high risk of ischemic stroke in these patients. At the 13-month follow-up, the patient remained stable with New York Heart Association class II heart failure. In conclusion, 2DTTE and CFI seem to be suitable initial methods for diagnosing Ps of the LV, but CMR is an excellent complementary method for characterizing further this cardiac entity. Furthermore, the long-term outcome of patients with Ps of the LV who are treated medically appears to be relatively benign |
| first_indexed | 2024-04-13T04:27:53Z |
| format | Article |
| id | doaj.art-b164d3955612461f85be7b8d88b30ebc |
| institution | Directory Open Access Journal |
| issn | 2055-0464 2055-0464 |
| language | English |
| last_indexed | 2024-04-13T04:27:53Z |
| publishDate | 2017-10-01 |
| publisher | BMC |
| record_format | Article |
| series | Echo Research and Practice |
| spelling | doaj.art-b164d3955612461f85be7b8d88b30ebc2022-12-22T03:02:26ZengBMCEcho Research and Practice2055-04642055-04642017-10-0144K37K4010.1530/ERP-17-0035Post-myocardial infarction left ventricular pseudoaneurysm diagnosed incidentally by echocardiographyRienzi Díaz-Navarro0Petros Nihoyannopoulos1Departamento de Medicina Interna, Escuela de Medicina, Universidad de Valparaíso, Valparaíso, ChileDepartment of Cardiovascular Sciences, Hammersmith Hospital, Imperial College London, NHLI, Hammersmith Hospital, London, UKA 54-year-old male developed a left ventricular pseudoaneurysm (Ps) along the lateral wall of the left ventricle (LV), which was diagnosed incidentally by two-dimensional transthoracic echocardiography (2DTTE) 6 months after an acute myocardial infarction. Color flow imaging (CFI) showed blood flow from the LV into the aneurysmal cavity and invasive coronary angiography revealed sub-occlusion of the circumflex artery. A complementary study using cardiovascular magnetic resonance (CMR) confirmed a dilated left ventricle with depressed ejection fraction, thin dyskinetic anterolateral and inferolateral walls, a Ps adjacent to the lateral wall of the LV contained by the pericardium and blood passing in and out through a small defect in the LV mid-anterolateral wall. Late gadolinium-enhanced imaging demonstrated transmural myocardial infarction in the lateral wall and delayed enhancement of the pericardium, which formed the walls of the Ps. A conservative approach was adopted in this case, optimizing the patient’s heart failure medications, including cardioselective beta-blocker agents, angiotensin-converting enzyme inhibitors, spironolactone and chronic anticoagulation therapy because of a high risk of ischemic stroke in these patients. At the 13-month follow-up, the patient remained stable with New York Heart Association class II heart failure. In conclusion, 2DTTE and CFI seem to be suitable initial methods for diagnosing Ps of the LV, but CMR is an excellent complementary method for characterizing further this cardiac entity. Furthermore, the long-term outcome of patients with Ps of the LV who are treated medically appears to be relatively benignhttp://www.echorespract.com/content/4/4/K37.fullacute myocardial infarctioncardiac imagingheart failureleft ventricular pseudoaneurysmtransthoracic Doppler echocardiography |
| spellingShingle | Rienzi Díaz-Navarro Petros Nihoyannopoulos Post-myocardial infarction left ventricular pseudoaneurysm diagnosed incidentally by echocardiography Echo Research and Practice acute myocardial infarction cardiac imaging heart failure left ventricular pseudoaneurysm transthoracic Doppler echocardiography |
| title | Post-myocardial infarction left ventricular pseudoaneurysm diagnosed incidentally by echocardiography |
| title_full | Post-myocardial infarction left ventricular pseudoaneurysm diagnosed incidentally by echocardiography |
| title_fullStr | Post-myocardial infarction left ventricular pseudoaneurysm diagnosed incidentally by echocardiography |
| title_full_unstemmed | Post-myocardial infarction left ventricular pseudoaneurysm diagnosed incidentally by echocardiography |
| title_short | Post-myocardial infarction left ventricular pseudoaneurysm diagnosed incidentally by echocardiography |
| title_sort | post myocardial infarction left ventricular pseudoaneurysm diagnosed incidentally by echocardiography |
| topic | acute myocardial infarction cardiac imaging heart failure left ventricular pseudoaneurysm transthoracic Doppler echocardiography |
| url | http://www.echorespract.com/content/4/4/K37.full |
| work_keys_str_mv | AT rienzidiaznavarro postmyocardialinfarctionleftventricularpseudoaneurysmdiagnosedincidentallybyechocardiography AT petrosnihoyannopoulos postmyocardialinfarctionleftventricularpseudoaneurysmdiagnosedincidentallybyechocardiography |