Methodist Journal

FEATURED GUEST EDITOR

ISSUE INTRO

The Burgeoning Field of Cardio-Oncology

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RECOGNITIONS

Barry H. Trachtenberg Leads Issue on Cardio-Oncology

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REVIEW ARTICLES See More

Heart Failure in Relation to Anthracyclines and Other Chemotherapies

Heart Failure in Relation to Tumor-Targeted Therapies and Immunotherapies

The Role of Cardiovascular Imaging and Serum Biomarkers in Identifying Cardiotoxicity Related to Cancer Therapeutics

Prevention and Treatment of Chemotherapy-Induced Cardiotoxicity

Cardiovascular Toxicities of Radiation Therapy

Electrophysiologic Complications in Cancer Patients

Vascular Toxicity in Patients with Cancer: Is There a Recipe to Clarify Treatment?

Future Directions in Cardio-Oncology

CASE REPORTS See More

A Rare Case of Pancreatitis-Induced Thrombosis of the Aorta and Superior Mesenteric Artery

Anomalous Origin of the Right Coronary Artery from the Left Main Coronary Artery in the Setting of Critical Bicuspid Aortic Valve Stenosis

Simultaneous Transfemoral Mitral and Tricuspid Valve in Ring Implantation: First Case Report with Edwards Sapien 3 Valve

Uneventful Follow-Up 2 Years after Endovascular Treatment of a High Flow Iatrogenic Aortocaval Fistula Causing Pulmonary Hypertension and Right Heart Failure

MUSEUM OF HMH MULTIMODALITY IMAGING CENTER See More

Do Not Pass Flow: Microvascular Obstruction on Cardiac Magnetic Resonance After Reinfarction Following Primary Percutaneous Coronary Intervention

CLINICAL PERSPECTIVES See More

EXCERPTA

Cardio-Oncology, Then and Now: An Interview with Barry Trachtenberg

POINTS TO REMEMBER

Onconephrology: An Evolving Field

POINTS TO REMEMBER

Herbal Nephropathy

EXCERPTA

Rolling the Dice on Red Yeast Rice

EDITORIALS

Letter to the Editor in Response to “Cardiac Autonomic Neuropathy in Diabetes Mellitus”

Vol 13, Issue 3 (2017)

Article Full Text

MUSEUM OF HMH MULTIMODALITY IMAGING CENTER

Late Left Ventricular Pseudoaneurysm after Acute Myocardial Infarction

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Article Citation:

Alshammari BS, Reardon MJ, Nabi F. Late Left Ventricular Pseudoaneurysm after Acute Myocardial Infarction. Methodist DeBakey Cardiovasc J. 2017;13(3):169-171

doi: 10.14797/mdcj-13-3-169

Keywords
cardiac magnetic resonance imaging , pseudoaneurysm , long inversion time imaging

A 71-year-old female with diabetes and recent quadruple coronary artery bypass grafting for acute coronary syndrome 8 months prior presented with worsening shortness of breath on minimal exertion, orthopnea, and fatigue. She was found to have a large left ventricular (LV) mass on a computer tomography chest scan and transferred to our hospital for further management.

The patient underwent cardiac magnetic resonance imaging (CMR) for further evaluation. CMR images demonstrated a free wall rupture of the basal inferolateral wall that resulted in a large LV pseudoaneurysm (Figures A, B). Long inversion time (TI) imaging after administration of gadolinium showed a large thrombus burden within the LV pseudoaneurysm (Figures C, D). There also was a marked delayed hyperenhancement of the adherent pericardium (Figure E).

LV pseudoaneurysms form when a free wall rupture is contained by adherent pericardium (most frequently in the posterior wall, followed by the lateral and apical walls).1,2 A pseudoaneurysm is traditionally characterized by a small neck communication between the left ventricle and aneurysmal cavity in which the ratio of the diameter of entry and the maximal diameter of the pseudoaneurysm is < 0.5.3 One of the distinguishing features of LV pseudoaneurysm compared with true aneurysm on CMR is marked delayed enhancement of the surrounding pericardium.4 Left ventricular pseudoaneurysms have a 30% to 45% risk of rupture and a mortality rate of almost 50% when treated medically.5,6 Thus, surgery is the preferred therapeutic option.

The patient promptly underwent cardiac surgery, which confirmed an inferolateral LV pseudoaneurysm (Figure F) with a small neck of LV pseudoaneurysm and a large lining thrombus (asterisk) shown in Figure G. She underwent uneventful LV pseudoaneurysm excision with patch repair (Figure H, I).

cardiac magnetic resonance imaging reveals free wall rupture of basal inferolateral wall with left ventricular pseudoaneurysm. Long time inversion image with gadolinium shows large thrombus within pseuydoaneuryrsm.

delayed hyperenhacement of pericaridum with left ventricular pseydoaneurysminferolateral left ventricular pseudoaneurysm and large thrombus before and after excision with patch repair

References

  1. Dachman AH, Spindola-Franco H, Solomon N. Left ventricular pseudoaneurysm. Its recognition and significance. JAMA 1981 Oct 23-30;246(17):1951-3.
  2. Frances C, Romero A, Grady D. Left ventricular pseudoaneurysm. J Am Coll Cardiol. 1998 Sep;32(3):557-61.
  3. Yeo TC, Malouf JF, Oh JK, Seward JB. Clinical profile and outcome in 52 patients with cardiac pseudoaneurysm. Ann Intern Med. 1998 Feb 15;128(4):299-305.
  4. Konen E, Merchant N, Gutierrez C, et al. True versus false left ventricular aneurysm: differentiation with MR imaging–initial experience. Radiology. 2005 Jul;236(1):65-70.
  5. Vlodaver Z, Coe JI, Edwards JE. True and false left ventricular aneurysms. Propensity for the altter to rupture. Circulation. 1975 Mar;51(3):567-72.
  6. Bolooki H. Surgical treatment of complications of acute myocardial infarction. JAMA. 1990 Mar 2;263(9):1237-40.

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