Rapidly Progressing Fatal Left Ventricular Pseudoaneurysm After Acute Myocardial Infarction - A Case Report of Delayed Diagnosis

Left ventricular pseudoaneurysm (LVPA) is a rare complication of acute myocardial infarction (MI). As pseudoaneurysm is contained by the pericardium alone without involvement of myocardial tissue, LVPA are more prone to rupture and hence necessitates surgical intervention. We report a case of a 60-year-old man with acute MI due to a three-way occlusion in the coronary arteries. An emergency transthoracic echocardiogram (TTE) on the 11th day after the MI showed a small ventricular aneurysm, which was probably a late complication of the acute MI episode. A repeat TTE on the 26th day of the MI episode revealed a rapidly progressing LVPA. Emergency heart surgery was planned, but the patient died due to LVPA rupture. This case illustrates timely diagnosis and corrective surgery are key to saving patients from fatal LVPAs

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The evolution of left ventricular pseudoaneurysm from the rupture of left ventricular free wall following acute myocardial infarction: a case report

BMC Cardiovascular Disorders ◽

10.1186/s12872-019-01321-2 ◽

2020 ◽

Vol 20 (1) ◽

Author(s):

Xin Li ◽

Yu Wang ◽

Dong Wang ◽

Chaohui Lai ◽

Chenxin Wang

Keyword(s):

Myocardial Infarction ◽

Acute Myocardial Infarction ◽

Conservative Treatment ◽

Rare Complication ◽

Coronary Revascularization ◽

Reperfusion Therapy ◽

Left Ventricular ◽

Free Wall ◽

Left Ventricular Pseudoaneurysm ◽

Pseudoaneurysm Formation

Abstract Background Left ventricular pseudoaneurysm is a very rare complication following acute myocardial infarction, which results from a free wall rupture. Hemopericardium and cardiac tamponade caused by rupture of the free wall after acute myocardial infarction are often fatal. It is difficult to fully document the evolution of left ventricular pseudoaneurysm resulted from acute myocardial infarction with conservative treatment. Case presentation Herein, we followed a 75-year-old female patient for 3 years. Recorded the evolution of the disease: acute lateral myocardial infarction - emergency reperfusion therapy - cardiac rupture - positive successful rescue - the pseudoaneurysm formation - maintaining conservative treatment - gradual enlargement of the pseudoaneurysm - thrombosis in pseudoaneurysm - thrombus filling with pseudoaneurysm - finally stabilized condition - the treatment of coronary revascularization. Conclusions This case is reported here because of its scarcity, which provides provides us with a complete record of the entire evolution and an astonishing indication of the long-term prognosis of non-surgical treatment for pseudoventricular.

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The unique mechanism of functional mitral regurgitation in acute myocardial infarction: a prospective dynamic 4D quantitative echocardiographic study

European Heart Journal - Cardiovascular Imaging ◽

10.1093/ehjci/jey177 ◽

2018 ◽

Vol 20 (4) ◽

pp. 396-406 ◽

Cited By ~ 5

Author(s):

Toshiyuki Kimura ◽

Véronique L Roger ◽

Nozomi Watanabe ◽

Sergio Barros-Gomes ◽

Yan Topilsky ◽

...

Keyword(s):

Myocardial Infarction ◽

Acute Myocardial Infarction ◽

Mitral Regurgitation ◽

Regional Wall Motion ◽

Sudden Onset ◽

Left Ventricular ◽

3D Echocardiography ◽

Functional Mitral Regurgitation ◽

Acute Mi ◽

Mitral Apparatus

Abstract Aims Mechanisms of chronic ischaemic mitral regurgitation (IMR) are well-characterized by apically tethered leaflet caused by papillary muscles (PMs) displacement and adynamic mitral apparatus. We investigated the unique geometry and dynamics of the mitral apparatus in first acute myocardial infarction (MI) by using quantified 3D echocardiography. Methods and results We prospectively performed 3D echocardiography 2.3 ± 1.8 days after first MI, in 174 matched patients with (n = 87) and without IMR (n = 87). 3D echocardiography of left ventricular (LV) volumes and of mitral apparatus dynamics throughout cardiac cycle was quantified. Similar mitral quantification was obtained at chronic post-MI stage (n = 44). Mechanistically, acute IMR was associated with larger and flatter annulus (area 9.29 ± 1.74 cm2 vs. 8.57 ± 1.94 cm2, P = 0.002, saddle shape 12.7 ± 4.5% vs. 15.0 ± 4.6%, P = 0.001), and larger tenting (length 6.36 ± 1.78 mm vs. 5.60 ± 1.55 mm, P = 0.003) but vs. chronic MI, mitral apparatus displayed smaller alterations (all P < 0.01) and annular size, PM movement remained dynamic (all P < 0.01). Specific to acute IMR, without PM apical displacement (P > 0.70), greater separation (21.7 ± 4.9 mm vs. 20.0 ± 3.4 mm, P = 0.01), and widest angulation of PM (38.4 ± 6.2° for moderate vs. 33.5 ± 7.3° for mild vs. 31.4 ± 6.3° for no-IMR, P = 0.0009) wider vs. chronic MI (P < 0.01). Conclusions 3D echocardiography of patients with first MI provides insights into unique 4D dynamics of the mitral apparatus in acute IMR. Mitral apparatus remained dynamic in acute MI and distinct IMR mechanism in acute MI is not PM displacement seen in chronic IMR but separation and excess angulation of PM deforming the mitral valve, probably because of sudden-onset regional wall motion abnormality without apparent global LV remodelling. This specific mechanism should be considered in novel therapeutic strategies for IMR complicating acute MI.

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