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      Left Ventricular Pseudoaneurysm after Valve Replacement

      case-report

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          Abstract

          We present a case of left ventricular pseudoaneurysm, which is a very rare and fatal complication of cardiac procedures such as mitral valve replacement. A 55-year-old woman presented to the Department of Thoracic and Cardiovascular Surgery at Hanyang University Seoul Hospital with chest pain. Ten years prior, the patient had undergone double valve replacement due to aortic regurgitation and mitral steno-insufficiency. Surgical repair was successfully performed using a prosthetic pericardial patch via a left lateral thoracotomy.

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          Left ventricular pseudoaneurysm.

          Craig D. Frances, Anthony Romero, Deborah Grady (1998)
          Left ventricular (LV) pseudoaneurysms form when cardiac rupture is contained by adherent pericardium or scar tissue. Although LV pseudoaneurysms are not common, the diagnosis is difficult and they are prone to rupture. We evaluated the clinical presentation, diagnostic accuracy of imaging modalities, results of therapy and prognosis of 290 patients with LV pseudoaneurysms. Most cases of LV pseudoaneurysm were related to myocardial infarction (particularly inferior wall myocardial infarction) and cardiac surgery. Congestive heart failure, chest pain and dyspnea were the most frequently reported symptoms, but >10% of patients were asymptomatic. Physical examination revealed a murmur in 70% of patients. Almost all patients had electrocardiographic abnormalities, but these were usually nonspecific ST segment changes; only 20% of patients had ST segment elevation. Although radiographic findings were also usually nonspecific, the appearance of a mass was present in more than one half of patients and may be an important clue to the correct diagnosis. Left ventricular angiography was the most definitive test and can be useful in planning surgery since concomitant coronary angiography can be performed. Regardless of treatment, patients with LV pseudoaneurysms had a high mortality rate, especially those who did not undergo surgery. Because the symptoms, signs, electrocardiographic abnormalities and radiographic findings seen in patients with LV pseudoaneurysms can be indistinguishable from those in patients with coronary disease alone, a high clinical index of suspicion is needed to avoid missing the diagnosis.
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            Causes of early postoperative death following cardiac valve replacement. Clinico-pathologic correlations in 64 patients studied at necropsy.

            W C Roberts, A G Morrow (1967)
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              Left Ventricular Pseudo-pseudoaneurysm with Hemopericardium

              Hye-Seon Kim, Kyung Hwan Kim, Ho Hwang (2011)
              We report a case of pseudo-pseudoaneurysm, which is a very rare complication of myocardial infarction. A 69-year-old man was admitted to our clinic with chest tightness and dyspnea. He had undergone aortic valve replacement with a pericardial bioprosthetic valve, ring mitral annuloplasty, and reconstruction of an aortic annular defect due to infective endocarditis with bovine pericardium 4 years prior. Echocardiography and computed tomography showed pericardial effusion and a 16-mm cavity at the anterolateral wall of the left ventricle. Magnetic resonance imaging suggested either pseudo-pseudoaneurysm or myocardial abscess. We successfully repaired the myocardial defect using a patch made from a vascular graft with pledgeted horizontal mattress sutures under cardiopulmonary bypass.
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                Author and article information

                Journal
                Journal ID (nlm-ta): Korean J Thorac Cardiovasc Surg
                Journal ID (iso-abbrev): Korean J Thorac Cardiovasc Surg
                Title: The Korean Journal of Thoracic and Cardiovascular Surgery
                Publisher: The Korean Society for Thoracic and Cardiovascular Surgery
                ISSN (Print): 2233-601X
                ISSN (Electronic): 2093-6516
                Publication date (Print): February 2015
                Publication date (Electronic): 05 February 2015
                Volume: 48
                Issue: 1
                Pages: 63-66
                Affiliations
                [1 ]Department of Thoracic and Cardiovascular Surgery, Hanyang University Seoul Hospital, Hanyang University College of Medicine
                [2 ]Department of Radiology, Hanyang University Seoul Hospital, Hanyang University College of Medicine
                [3 ]Department of Thoracic and Cardiovascular Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine
                Author notes
                Corresponding author: Hyuck Kim, Department of Thoracic and Cardiovascular Surgery, Hanyang University Seoul Hospital, Hanyang University College of Medicine, 222 Wangsimni-ro, Seongdong-gu, Seoul 133-791, Korea (Tel) 82-2-2290-8467 (Fax) 82-2-2290-8467 (E-mail) khkim@ 123456hanyang.ac.kr
                Article
                Publisher ID: kjtcvs-48-63
                DOI: 10.5090/kjtcs.2015.48.1.63
                PMC ID: 4333850
                SO-VID: 8cde3627-b9e9-4185-b752-ef4207f8065c
                Copyright © Copyright © 2015 by The Korean Society for Thoracic and Cardiovascular Surgery. All rights Reserved.
                License:

                This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                Date received : 04 September 2014
                Date accepted : 23 September 2014
                Categories
                Subject: Case Report

                ScienceOpen disciplines: Surgery
                Keywords: left ventricular pseudoaneurysm,left ventricular rupture,mitral valve, replacement
                Data availability:
                ScienceOpen disciplines: Surgery
                Keywords: left ventricular pseudoaneurysm, left ventricular rupture, mitral valve, replacement

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