Images in cardiovascular medicine. Postoperative left ventricular pseudoaneurysm.

摘要: Left ventricular pseudoaneurysms are formed when myocardial rupture is contained by pericardial adhesions and thrombus formation. 1 Although rare, false aneurysms of the left ventricle can occur after mitral valve surgery or infarction. 2 These pseudoaneurysms, visceral pericardium alone, have a tendency to with catastrophic complications. Advances in noninvasive imaging recent years resulted detection previously unsuspected pseudoaneurysms. 3 On ultrasound, both exhibit systolic expansion; however, only rapid flow through aneurysmal neck during systole diastole. 4 A 75-year-old woman no coronary artery disease underwent replacement for severe regurgitation associated congestive heart failure. A 31-mm was implanted. The procedure complicated free-wall rupture, × cm size, which repaired bovine patch BioGlue® surgical adhesive (CryoLife International®, Inc.; Kennesaw, Ga). An echocardiogram performed 2½ months did not reveal any abnormal shunting. However, weeks later, patient's failure worsened, cardiac echocardiography revealed dehiscence (Figs. 1–3). patient returned repair. space found be obliterated adhesions, pseudoaneurysm filled large amount thrombus. BioGlue had completely separated from myocardium, leaving 4- 6-cm defect. previous were removed. New patches placed on epicardial endocardial sides defect (double-patch repair). successful, discharged hospital doing well. Fig. Apical 4-chamber view shows lack myocardium lateral wall ventricle, cavity (*). Fig. color Doppler echocardiogram, off-axis view, broad jet pseudoaneurysm, indicating blood into cavity. Fig. pulse-wave apical reveals diastole, pathognomonic pseudoaneurysm.