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01 November 2005

A case of left ventricular pseudoaneurysm with long survival and congestive heart failure as first presentation. Case report and review of the literature.

Nikolaos Varvarigos, Efstratios Koletsis, Athanasios Zafiropoulos, Harilaos Papaioannou, Harilaos Papaioannou

Med Sci Monit 2005; 11(11): CS69-73 :: ID: 430399

Abstract

Background: Left ventricular pseudoaneurysm is a rare and extremely fatalcomplication of acute myocardial infarction. It is defined as a rupture of the myocardium contained byepicardial adhesions or the epicardial wall. Case Report: A 76-year-old woman was brought to our departmentsuffering from acute pulmonary edema and left ventricular pseudoaneurysm. This condition was caused byan unrecognized high lateral myocardial infarction, which was diagnosed and treated conventionally. Fouryears after the diagnosis was made, the patient is in good physical condition. The presentation, imagingfindings, and the prognosis of such cases are briefly discussed. We have especially focused on the imagingtechniques currently used to confirm the diagnosis and on the fact that although the patient refusedto have an operation (most appropriate for the diagnosis), she still lives in good physical condition(NYHA II). Conclusions: We report a case of post infarction pseudoaneurysm along with review of the literatureon the subject. We discuss the role of computed tomography and magnetic resonance imaging to ascertainthe diagnosis and the algorithm of therapeutic management. Based on current literature, we believe thatsurgical resection is the treatment of choice for patients in whom a pseudoaneurysm is detected withinthree months after myocardial infarction, for patients with other indications for cardiac surgery, andfor symptomatic patients with ventricular tachycardia or recurrent embolism related to the pseudoaneurysm.Optimum medical therapy is the only alternative in those high-risk patients who refuse surgical operation.

Keywords: Aneurysm, False - radiography, Heart Aneurysm - radiography, Heart Failure - radiography, Magnetic Resonance Imaging, Myocardial Infarction - complications, Prognosis, Tomography, X-Ray Computed, Ventricular Dysfunction, Left - radiography

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Medical Science Monitor eISSN: 1643-3750
Medical Science Monitor eISSN: 1643-3750