An Asymptomatic Left Ventricular Pseudoaneurysm found incidentally at 12 months post Myocardial Infarction: Case Report and Review of the Literature

2020 ◽  
Vol 20 ◽  
Author(s):  
Christian Brooks ◽  
Heather Cooke
Keyword(s):  
Myocardial Infarction ◽  
Surgical Repair ◽  
Left Ventricular ◽  
Mechanical Complication ◽  
Review Of The Literature ◽  
Limited Data ◽  
Left Ventricular Pseudoaneurysm ◽  
History Of ◽  
Multi Disciplinary Team

Highlights: Left ventricular pseudoaneurysms are a rare mechanical complication of myocardial infarction. If found acutely following infarction (within 2 weeks, with some advocating up to 3 months), surgical repair is recommended due to their high risk of rupture.Whilst associated with chest pain, dyspnoea and heart failure, some individuals are asymptomatic, with the diagnosis made incidentally on routine follow-up often months to years post infarction. Less is known about the natural history of these chronic pseudoaneurysms, with concerns around their propensity to rupture perhaps less than the mortality risk of surgical repair.We present the case of a 70 year-old asymptomatic man who was found to have a 1.6cm left ventricular pseudoaneurysm found incidentally on routine transthoracic echocardiogram. at 12-months post posterior myocardial infarctionThe consensus opinion of our institution's multi-disciplinary team regarding further management of this patient, with reference to the current limited data on chronic pseudoaneurysms, will be discussed.

Can left ventricular global function index be a novel marker of unfavorable outcome in patients with acute coronary syndrome

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
L Minushkina ◽  
V Brazhnik ◽  
N Selezneva ◽  
V Safarjan ◽  
M Alekhin ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Myocardial Infarction ◽  
Heart Failure ◽  
Acute Coronary Syndrome ◽  
Left Ventricular ◽  
Global Function ◽  
Coronary Syndrome ◽  
History Of ◽  
Coronary Events

Abstract   Left ventricular (LV) global function index (LVGFI) is a MRI marker of left ventricular remodeling. LVGFI has high predictive significance in young healthy individuals. The aim of the study was to assess prognostic significance in patients with acute coronary syndrome (ACS). We include into this analysis 2169 patients with ACS (1340 (61.8%) men and 829 (38.2%) women), mean age 64.08±12.601 years. All patients were observed in 2 Russian multicenter observational studies: ORACLE I (ObseRvation after Acute Coronary syndrome for deveLopment of trEatment options) (2004–2007 years) and ORACLE II (NCT04068909) (2014–2019 years). 1886 (87.0%) pts had arterial hypertension, 1539 (71.0%) – history of coronary artery disease, 647 (29.8%) – history of myocardial infarction, 444 (20.5%) - diabetes mellitus. Duration of the follow-up was 1 years after the hospital discharge. Cases of death from any cause, coronary deaths, repeated coronary events (fatal and non-fatal) were recorded. An echocardiographic study was conducted 5–7 days from the time of hospitalization. The LVGFI was defined as LV stroke volume/LV global volume × 100, where LV global volume was the sum of the LV mean cavity volume ((LV end-diastolic volume + LV end-systolic volume)/2) and myocardial volume (LV mass/density). During the follow-up, 193 deaths were recorded (8.9%), 122 deaths (5.6%) were coronary. In total, repeated coronary events were recorded in 253 (11.7%) patients. Mean LVGFI was 22.64±8.121%. Patients who died during the follow-up were older (73.03±10.936 years and 63.15±12.429 years, p=0.001), had a higher blood glucose level at the admission to the hospital (8.12±3.887 mmol/L and 7.17±3.355 mmol/L, p=0.041), serum creatinine (110.86±53.954 μmol/L and 99.25±30.273 μmol/L, p=0.007), maximum systolic blood pressure (196.3±25.17 mm Hg and 190.3±27.83 mm Hg, p=0.042). Those who died had a lower LVGFI value (19.75±6.77% and 23.01±8.243%, p<0.001). Myocardial mass index, ejection fraction and other left ventricular parameters did not significantly differ between died and alive patients. Among the patients who died, there were higher rate of women, pts with a history of myocardial infarction, heart failure, diabetes. In a multivariate analysis, diabetes mellitus OR1.67 95% CI [1.12–2.51] p=0.012, history of heart failure (1.78 [1.2.-2.59], p=0.003), a history of myocardial infarction (1.47 [1.05–2.05], p=0024), age (1.06 [1.05–1.08], p=0.001) and LVGFI <22% (1.53 [1.08–2.17], p=0.015) were independent predictors of death from any cause. The LVGFI was also independently associated with the risk of coronary death, but not with the risk of all recurring coronary events. Thus, LVGFI may be useful the marker to assess risk in patients who have experienced an ACS episode. Funding Acknowledgement Type of funding source: None

scholarly journals P1494 Incidental finding of aortic aneurysm formation following 34 years of coarctation repair by dacron patch aortoplasty

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
E A Khalifa ◽  
S Helmy ◽  
S F Mohamed ◽  
M Alkuwari
Keyword(s):  
Aortic Aneurysm ◽  
Aortic Arch ◽  
Subclavian Artery ◽  
Aortic Coarctation ◽  
Surgical Repair ◽  
Left Ventricular ◽  
Coarctation Repair ◽  
History Of ◽  
Dacron Patch

Abstract Introduction Aneurysms are found following all types of surgical repair of aortic coarctation, especially after Dacron patch aortoplasty. We describe the finding of an aortic aneurysm in an asymptomatic 52-year-old male, who was managed by Dacron patch aortoplasty for native coarctation of the aorta 34 years earlier. Case report A 52-year male, smoker, hypertensive on medication He had previous history of surgical repair of aortic coarctation at age of 18 years . Repair was by Dacron patch aortoplasty. Since then, his regular follow up was unremarkable. Recently, he was referred for cardiac evaluation as a part of pre-employment general check-up. He was asymptomatic with no history of shortness of breath or chest pain. Physical examination revealed that the pulse in the left arm was reduced in volume in comparison to the right one. The heart sounds were essentially normal but a pericardial murmur was audible, perhaps reflecting residual collateral flow. Blood pressure was 156/83 mmHg in right arm and 142/81 in the left arm. Transthoracic echocardiography revealed mild left ventricular hypertrophy with normal global and regional contractility and an ejection fraction of 58%. Supra sternal window images showed dilatation of the three aortic arch branches. The distal portion of aortic arch just distal to origin of left subclavian artery was narrowed with a peak systolic gradient across of 34 mmHg. A cystic structure (1.7 cm x 1.9 cm) was visualized attached to the narrowed segment of the aorta, suggestive of a saccular aneurysm, (figures A&B&C). Computed tomography aortogram showed a narrow-necked aneurysm arising from the posterolateral aspect of the distal aortic arch (anticipated site of the coarctation repair graft anastomosis). A small laminated thrombus was also noted within. Aneurysm measured approximately 2.2 x 3.3 cm in its craniocaudal and anteroposterior dimensions respectively, with no evidence of aortic luminal compromise. (figures D&E&F). Management Aneurysmectomy was performed subsequently. Interposition polyester grafts were used to reconstruct the aortic arch and proximal descending aorta and to connect this aortic segment to the subclavian artery via a lateral thoracotomy. The postoperative course thereafter was uneventful. Conclusion: This is a rare insidious complication of Dacron patch aortoplasty that occurred after more than 3 decades, which highlights the importance of diagnostic imaging in the follow up of these patients Abstract P1494 Figure.

scholarly journals A Case of Cardiac Calcified Amorphous Tumor Presenting with Concomitant ST-Elevation Myocardial Infarction and Occipital Stroke and a Brief Review of the Literature

2017 ◽  
Vol 2017 ◽  
pp. 1-4 ◽  
Author(s):  
Kyaw Kyaw ◽  
Htun Latt ◽  
Sammy San Myint Aung ◽  
Chanwit Roongsritong
Keyword(s):  
Myocardial Infarction ◽  
St Elevation Myocardial Infarction ◽  
Cardiac Tumors ◽  
Review Of The Literature ◽  
Limited Data ◽  
Systemic Embolization ◽  
St Elevation ◽  
Calcified Amorphous Tumor ◽  
Annular Calcification

Cardiac calcified amorphous tumor (CAT) is an extremely rare benign intracavitary tumor of the heart. It may mimic other cardiac tumors and can present with signs or symptoms of systemic embolization. There are limited data regarding CAT in the literature. We report a case of a 68-year-old woman with a cardiac CAT and mitral annular calcification (MAC), who presented with acute ST-elevation myocardial infarction (STEMI) and occipital stroke. After extensive review of the literature, we believe that this case is possibly the first description of a cardiac CAT presenting with STEMI. The CAT was surgically removed, and the diagnosis was confirmed by histology. The patient tolerated the surgery and reported no events at 6-month follow-up.

scholarly journals Delayed presentation of acute coronary syndrome with mechanical complication during COVID-19 pandemic: a case report

2020 ◽  
Author(s):  
Joo Hor Tan ◽  
Jieli Tong ◽  
Hee Hwa Ho
Keyword(s):  
Myocardial Infarction ◽  
Cardiac Tamponade ◽  
Left Ventricular ◽  
World Health ◽  
Mechanical Complication ◽  
Delayed Presentation ◽  
Left Circumflex Artery ◽  
Coronary Syndrome ◽  
History Of ◽  
The Impact

Abstract Background The World Health Organization declared coronavirus disease 2019 (COVID-19) a global pandemic on 11 March 2020. We report a patient with acute myocardial infarction (AMI) who presented late due to fears of contracting COVID-19. Case summary A 65-year-old man with a history of hypertension presented late to the emergency department (ED) with AMI. He gave a 2-month history of exertional angina but avoided seeking medical consult due to fears of contracting COVID-19. On the day of admission, he had 4 h of severe chest pain before presenting to the ED. He was hypotensive and tachycardic on arrival. Electrocardiogram showed inferolateral ST-elevation myocardial infarction. Chest radiograph revealed widened superior mediastinum and bedside echocardiogram revealed inferoseptal and inferolateral hypokinesia with features of cardiac tamponade. An urgent computed tomography aortogram showed possible left ventricular (LV) wall perforation with resulting haemopericardium and cardiac tamponade. Subsequent coronary angiogram showed 100% occlusion of mid left circumflex artery and a contained LV wall rupture was confirmed with LV ventriculogram. He was transferred to a tertiary centre and underwent successful emergency surgical repair. Discussion Our index case demonstrates the impact of the COVID-19 pandemic on health seeking behaviour due to fears of contracting COVID-19 and the ensuing impact of delayed medical intervention. Cardiologists worldwide are seeing an alarming rate of rare complications of AMI in patients who present late. Physicians need to be aware of this phenomenon and have an active role to play in public education.

Left Ventricular Pseudoaneurysm as a Complication of Myocardial Infarction; A Case Series and Review of the Literature

2021 ◽  
Author(s):  
Haleh Ashraf ◽  
Azadeh Sadatnaseri ◽  
Arya Aminorroaya ◽  
Zahra Kuhi ◽  
Nadia Zandi ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Rare Complication ◽  
Case Series ◽  
Left Ventricular ◽  
Left Ventricular Pseudoaneurysm ◽  
Parietal Pericardium ◽  
Cardiac Evaluation ◽  
Post Operation ◽  
History Of ◽  
Lost To Follow Up

Introduction: Pseudoaneurysm may occur as a rare complication of myocardial infarction (MI) when a hemorrhagic process is covered by adherence of the visceral or parietal pericardium or of both, preventing the formation of cardiac tamponade. Pseudoaneurysm is prone to rupture because they are not easy to diagnose. Case presentation: Here, we report three cases of left ventricular pseudo-aneurysm (LVP) that all were related to MI. Two patients were managed conservatively, one of them was lost to follow-up, and the other one expired one month later. One patient underwent surgery, but he expired during post-operation period. Conclusions: High mortality rate of LVP emphasizes the importance of looking for it in cardiac evaluation of patients with history of MI. Due to available non-invasive modalities, the ability to differentiate LVP from other cardiac pathologies is improving. Still, the most recommended management of LVP is early surgery.

Surgical Approach to Myocardial Rupture after Acute Myocardial Infarction

1998 ◽  
Vol 6 (2) ◽  
pp. 108-114 ◽  
Author(s):  
Chukwumere E Nwogu ◽  
John M Moran ◽  
Richard M Becker ◽  
A Thomas Pezzella
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Patient Survival ◽  
Left Ventricular ◽  
Short Term ◽  
Left Ventricular Pseudoaneurysm ◽  
Myocardial Rupture ◽  
Dimensional Echocardiography ◽  
Two Dimensional Echocardiography

Rupture of the ventricular wall is a highly lethal complication of acute myocardial infarction that is diagnosed more frequently with the increased use of two-dimensional echocardiography. External patching techniques were used to treat 4 patients with ventricular rupture, thus avoiding resection of necrotic myocardium. Three of the patients survived. One patient developed a large left ventricular pseudoaneurysm requiring reoperation. The other 2 patients had intact repairs on follow-up echocardiogram obtained after 5 weeks and 3 years, respectively. With prompt recognition and treatment, patient survival and excellent short-term results can be achieved.

scholarly journals Successful surgical repair of left ventricular pseudoaneurysm in a patient with subacute ST-elevation myocardial infarction

2021 ◽  
Author(s):  
Rosangela Cocchia ◽  
Gabriele Iannelli ◽  
Valentina Capone ◽  
Salvatore Chianese ◽  
Giuseppina Langella ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Surgical Repair ◽  
Left Ventricular ◽  
St Elevation Myocardial Infarction ◽  
Cardiac Rupture ◽  
Ventricular Wall ◽  
Left Ventricular Pseudoaneurysm ◽  
Life Saving ◽  
St Elevation

We report a successful surgical repair of left ventricular pseudoaneurysm in a patient with subacute ST-elevation myocardial infarction (STEMI). In the case of expansion of the infarct related ventricular wall, early (within 24 hours) or late (3-5 days after STEMI) cardiac rupture should be always borne in mind in order to proceed to life saving prompt surgical repair.

Pneumomediastinum: A Rare Presentation of Inflicted Injuries in Infants

2020 ◽  
Author(s):  
Adam Lee ◽  
Adam Bajinting ◽  
Abby Lunneen ◽  
Colleen M. Fitzpatrick ◽  
Gustavo A. Villalona
Keyword(s):  
Literature Review ◽  
Retrospective Review ◽  
Review Of The Literature ◽  
Rare Presentation ◽  
Spontaneous Pneumomediastinum ◽  
Nonaccidental Trauma ◽  
Comprehensive Literature Review ◽  
Healthy Infants ◽  
History Of

AbstractReports of incidental pneumomediastinum in infants secondary to inflicted trauma are limited. A retrospective review of infants with pneumomediastinum and history of inflicted trauma was performed. A comprehensive literature review was performed. Three infants presented with pneumomediastinum associated with inflicted trauma. Mean age was 4.6 weeks. All patients underwent diagnostic studies, as well as a standardized evaluation for nonaccidental trauma. All patients with pneumomediastinum were resolved at follow-up. Review of the literature identified other cases with similar presentations with related oropharyngeal injuries. Spontaneous pneumomediastinum in previously healthy infants may be associated with inflicted injuries. Clinicians should be aware of the possibility of an oropharyngeal perforation related to this presentation.

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