J Cardiovasc Ultrasound.  2010 Dec;18(4):161-164. 10.4250/jcu.2010.18.4.161.

Progression of Left Ventricular Pseudoaneurysm after an Acute Myocardial Infarction

• Kim MN
• Park SM
• Kim SW
• Lee KN
• Kim JS
• Kang EJ
• Ahn CM
• Shim WJ

• KMID: 2177321
• DOI: http://doi.org/10.4250/jcu.2010.18.4.161

Abstract

Left ventricular (LV) pseudoaneurysms rarely occur, but are detected more often with the development of new diagnostic tools. Since LV pseudoaneurysms are life-threatening, early surgical intervention is recommended. This report describes an 87-year-old woman with heart failure and a large LV pseudoaneurysm which progressed from a small LV pseudoaneurysm after an acute myocardial infarction over a 1-year period.

Keyword

Left ventricle; Pseudoaneurysm; Myocardial infarction

MeSH Terms

Aged, 80 and over
Aneurysm, False
Female
Heart Failure
Heart Ventricles
Humans
Myocardial Infarction

Figure

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  Fig. 1 Chest radiograph (A) shows cardiomegaly with a cardiothoracic ratio of 75%, pulmonary congestion, and a tortuous aorta. The electrocardiography (B) shows voltage criteria of LV hypertrophy and T wave inversion in leads V5 and V6, compatible with LV strain. LV: left ventricle.

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  Fig. 2 During the previous admission, transthoracic two-dimensional echocardiography (A) shows an echo-free space (arrow) with a maximal diameter of 22×11 mm and a neck of 15×17 mm. The myocardium at the neck abruptly stops, and a thrombotic plug is observed. Contrast echocardiography (B) shows better margin of the pseudoaneurysm (arrow) and no clear visualization of dye leakage to the pericardial space. LV: left ventricle.

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  Fig. 3 Cardiac magnetic resonance imaging during the previous admission shows a focal, bulging, sac-like lesion (arrow) without a definite peripheral wall in the lateral wall at the mid-LV level. LV: left ventricle.

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  Fig. 4 Transthoracic two-dimensional echocardiography on re-admission shows a large, echo-free space (*) behind the posterior wall, which communicates with the left ventricle through a narrow orifice, and an abrupt interruption of the myocardium at the neck is shown (A and B). The maximal diameter of the cavity is 80×55 mm and that of the orifice is 14×18 mm. A color Doppler study shows the blood fiows across the orifice from the LV to the cavity in systole (C) and from the cavity to the LV in diastole (D). Mild-to-moderate mitral regurgitation is observed in both systole (C) and diastole (D). LV: left ventricle.

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