Ann Thorac Surg 2001;71:1372
© 2001 The Society of Thoracic Surgeons
Images in cardiothoracic surgery
Giant left ventricular pseudoaneurysms
Ruggero De Paulis, MDa,
Giovanni M. De Matteis, MDa,
Luisa Colagrande, MDa,
Maria Michela Buratta, MDa,
Luigi Chiariello, MDa
a Department of Cardiac Surgery, University of Rome, Tor Vergata, Rome, Italy
Address reprint requests to Dr De Paulis, Cattedra di Cardiochirurgia, Università di Roma, Tor Vergata, European Hospital, via Portuense 700, 00149 Rome, Italy
e-mail: depauli{at}tin.it
A 70-year-old man, with chronic obstructive pulmonary disease, experienced an inferior myocardial infarction for which he received thrombolytic therapy at an outside hospital. Thirty days later, when a routine echocardiography revealed the presence of a left ventricular pseudoaneurysm, the patient was transferred to our institution. A repeat echocardiogram demonstrated a left ventricular pseudoaneurysm with dimensions similar to the left ventricular cavity. Figure 1 shows the echocardiographic parasternal long axis view demonstrating the pseudoaneurysm and its large neck (LV = left ventricle; RV = right ventricle; Ao = aorta). The patient underwent cardiac catheterization that confirmed the presence of a pseudoaneurysm, and revealed a total occlusion of the right coronary artery and a stenosis of a left anterior descending coronary artery. At surgery, the pseudoaneurysm had a dimension of approximately 10 x 5 x 5 cm with a large neck extending from the mitral valve to the apex of the heart. The patient underwent successful left ventricular endoaneurysmorrhaphy and single bypass to the left anterior descending coronary artery. He was discharged 10 days after surgery.
A 63-year-old male patient, who had undergone successful closure of a postinfarction septal defect 2 years previously, was admitted for a recent onset of rest dyspnea. Eight months previously, he had been started on anticoagulation therapy after an ischemic stroke. At that time, echocardiography revealed a normokinetic small left ventricle. After admission, X-ray showed an enlarged cardiac silhouette, and echocardiography revealed a huge left ventricular pseudoaneurysm. The diagnosis was immediately confirmed by magnetic resonance imaging. Figure 2 shows the magnetic resonance imaging short axis view (A) demonstrating a diaphragmatic pseudoaneurysm with a large neck and a measured internal dimension of 13.5 cm and long axis view (B) showing the pseudoaneurysm with a mean internal dimension of 10 cm (LV = left ventricle; Ps = pseudoaneurysm). Unfortunately, the patient died suddenly on his way to the operating room.
