Late recurrence of a giant left ventricular pseudoaneurysm: the importance of multimodality imaging approach

Left ventricular pseudoaneurysms (LVP) are rare but may arise after myocardial infarction, trauma or cardiac surgery, tending to expand and rupture over the time. We show the case of a 75-year-old patient with a recurrent giant ventricular pseudoaneurysm, who presented to the emergency department with sustained ventricular tachycardia. Pseudoaneurysmatic lesion was investigated through echocardiography, angiography and Cardiac Computed Tomography, in order to evaluate the size and spatial orientation of the pseudoaneurysm and to set a tailored treatment. At emergency department, sustained ventricular tachycardia may be the first and unique clinical presentation of ventricular pseudoaneurysm late recurrence, whose management requires a multimodality imaging approach to guide surgical correction.

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Myocardial rupture and left ventricular pseudoaneurysm due to late STEMI presentation during the COVID-19 pandemic lockdown: a classical case report

European Heart Journal - Case Reports ◽

10.1093/ehjcr/ytab253 ◽

2021 ◽

Vol 5 (7) ◽

Author(s):

Audra Banisauskaite ◽

Periaswamy Velavan ◽

Jonathan Hasleton ◽

Neeraj Mediratta ◽

Monika Arzanauskaite ◽

...

Keyword(s):

Chest Pain ◽

Systolic Function ◽

Multimodality Imaging ◽

Cardiac Computed Tomography ◽

Rare Complication ◽

Left Ventricular ◽

True Aneurysm ◽

Circumflex Artery ◽

Left Ventricular Pseudoaneurysm ◽

Lv Systolic Function

Abstract Background Left ventricular (LV) pseudoaneurysm is a serious and rare complication of myocardial infarction (MI). It occurs when an injured myocardial wall ruptures and is contained by overlying adherent pericardium or scar tissue, most commonly it develops in patients with late presentation of MI and delayed revascularization. Case summary A 64-year-old man presented to the emergency department with intermittent central chest pain radiating to back and neck and increasing on deep inspiration, which was considered to be of musculoskeletal origin for a week, but worsened despite medications. Electrocardiography showed features of ST-elevation MI; a circumflex artery occlusion was found on coronary angiogram and angioplasty was performed. Cardiovascular magnetic resonance (CMR) revealed features of healed lateral wall rupture with adherent parietal pericardium and the patient was managed conservatively. Two months later the patient returned with severe chest pain; echocardiogram and cardiac computed tomography showed significant interval progression of the pseudoaneurysm. Aneurysmectomy was performed, after which the patient recovered and had none of the previous symptoms since. Follow-up CMR study revealed improvement of LV systolic function. Discussion A rare case of post-infarction LV pseudoaneurysm was reported. Multimodality imaging helped to detect and to differentiate this complication from the true aneurysm and to follow it up and plan the treatment. Conservative treatment was not effective in this case as the pseudoaneurysm progressed; aneurysmectomy helped to improve LV systolic function.

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Different Substrates of Non-Sustained Ventricular Tachycardia in Post-infarction Patients With and Without Left Ventricular Dilatation

Journal of Cardiac Failure ◽

10.1016/j.cardfail.2009.09.001 ◽

2010 ◽

Vol 16 (1) ◽

pp. 61-68 ◽

Cited By ~ 9

Author(s):

Gianluca Di Bella ◽

Claudio Passino ◽

Giovanni Donato Aquaro ◽

Daniele Rovai ◽

Elisabetta Strata ◽

...

Keyword(s):

Ventricular Tachycardia ◽

Left Ventricular ◽

Sustained Ventricular Tachycardia ◽

Ventricular Dilatation ◽

Left Ventricular Dilatation

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Left Ventricular Pseudoaneurysm Caused by Radiofrequency Catheter Ablation: From Diagnosis to Treatment With Multimodality Imaging

Circulation Cardiovascular Imaging ◽

10.1161/circimaging.121.012820 ◽

2021 ◽

Author(s):

Joseph Nicolazzi ◽

John Grizzard ◽

Vigneshwar Kasirajan ◽

Kenneth Ellenbogen ◽

Roshanak Markley

Keyword(s):

Catheter Ablation ◽

Radiofrequency Catheter Ablation ◽

Multimodality Imaging ◽

Left Ventricular ◽

Left Ventricular Pseudoaneurysm

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P-195 Linear and non-linear indices of heart rate variability preceding non sustained ventricular tachycardia in patients with coronary artery disease and depressed left ventricular function

EP Europace ◽

10.1016/eupace/4.supplement_2.b112-b ◽

2003 ◽

Vol 4 (Supplement_2) ◽

pp. B112-B112

Author(s):

G. Goranitou ◽

A. Charissis ◽

D. Benetatos ◽

N. Kouris ◽

D. Babalis

Keyword(s):

Coronary Artery Disease ◽

Heart Rate ◽

Heart Rate Variability ◽

Ventricular Tachycardia ◽

Coronary Artery ◽

Left Ventricular Function ◽

Ventricular Function ◽

Left Ventricular ◽

Sustained Ventricular Tachycardia ◽

Artery Disease

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Diabetes and arrhythmias

ESC CardioMed ◽

10.1093/med/9780198784906.003.0221 ◽

2018 ◽

pp. 941-944

Author(s):

Heikki Huikuri ◽

Lars Rydén

Keyword(s):

Heart Failure ◽

Ventricular Tachycardia ◽

Sudden Cardiac Death ◽

Vitamin K ◽

Cardiac Death ◽

Vitamin K Antagonists ◽

Left Ventricular ◽

Sustained Ventricular Tachycardia ◽

Patients With Diabetes ◽

Diagnostic Work

Cardiac arrhythmias are more common in subjects with diabetes mellitus (DM) than in their counterparts without diabetes. Atrial fibrillation (AF) is present in 10–20% of the DM patients, but the association between DM and AF is mostly due to co-morbidities of DM patients increasing the vulnerability to AF. When type 2 DM and AF coexist, there is a substantially higher risk of cardiovascular mortality, stroke, and heart failure, which indicates screening of AF in selected patients with DM. Anticoagulant therapy either with vitamin K antagonists or non-vitamin K antagonist oral anticoagulants is recommended for DM patients with either paroxysmal or permanent AF, if not contraindicated. Palpitations, premature ventricular beats, and non-sustained ventricular tachycardia are common in patients with DM. The diagnostic work-up and treatment of these arrhythmias does not differ between the patients with or without DM. The diagnosis and treatment of sustained ventricular tachycardia, either monomorphic or polymorphic ventricular tachycardia, or resuscitated ventricular fibrillation is also similar between the patients with or without DM. The risk of sudden cardiac death is higher in DM patients with or without a diagnosed structural heart disease. Patients with diabetes and a left ventricular ejection fraction less than 30–35% should be treated with a prophylactic implantable cardioverter defibrillator according to current guidelines. Beta-blocking therapy is recommended for DM patients with left ventricular dysfunction or heart failure to prevent sudden cardiac death due to arrhythmia.

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3255Characterization of the arrhythmogenic substrate with multimodality imaging in ischemic patients undergoing VT ablation: relationship between cardiac computed tomography and magnetic resonance

European Heart Journal ◽

10.1093/eurheartj/ehz745.0047 ◽

2019 ◽

Vol 40 (Supplement_1) ◽

Author(s):

G Zucchelli ◽

D Soto Iglesias ◽

B Jauregui ◽

C Teres ◽

D Penela ◽

...

Keyword(s):

Computed Tomography ◽

Magnetic Resonance ◽

Cardiac Ct ◽

Low Voltage ◽

Multimodality Imaging ◽

Cardiac Computed Tomography ◽

Left Ventricular ◽

Left Ventricular Ejection ◽

Ventricular Ejection Fraction ◽

Arrhythmogenic Substrate

Abstract Background Cardiac magnetic resonance (CMR)-aided ventricular tachycardia (VT) substrate ablation has shown to improve VT recurrence-free survival, through a better identification of the arrhythmogenic substrate. However, the access to CMR may be limited in certain centers or sometimes Its use can be contraindicated in patients with cardiac implantable electronic device. Cardiac computed tomography (CT) has shown to improve the results of substrate ablation, correlating with low-voltage areas and local abnormal ventricular activity, and identifying ridges of myocardial tissue (CT-channels) that may be appropriate target sites for ablation. Purpose To evaluate the correlation between CT and CMR imaging in identifying anatomical heterogeneous tissue channels (CMR-channels) or CT-channels in ischemic patients undergoing VT substrate ablation. Methods The study included 30 post-myocardial infarction (MI) patients (mean age 69±10; 94% male, left ventricular ejection fraction 35±10%), who underwent both CMR and cardiac CT before VT substrate ablation. Using a dedicated post-processing software, the myocardium was segmented in 10 layers from endocardium to epicardium both for the CMR and CT, characterizing the presence of CMR-channels and CT-channels, respectively, by two blinded operators, assigned either to CMR or CT analysis. CMR-channels were classified as endocardial (CMR-channels in layer <50%), epicardial (CMR-channels in layers ≥50%) or transmural (in both endo and epicardial layers). Presence and location of CT and CMR-channels were compared. Results In 26/30 patients (86.7%) 91 CT-channels (mean 3.0±1.9 per patient) were identified while 30/30 (100%) showed CMR-channels (n=76; mean 2.4±1.2 per patient). We found 190 CT-channel entrances (mean 6.3±4.1 per patient), and 275 CMR-channel entrances (mean 8.9±4.9 per patient) on cardiac CT and CMR, respectively. There were 47/91 (51.6%) true positive CT-channels. On the contrary, 44/91 (48.4%) CT-channels were considered false positives [19/91 (20.9%) identified out of CMR scar], and 29/76 (38.2%) CMR-channels could not be identified on CT. Thirty-six out of 76 (47.4%) CMR-channels were considered as non-endocardial (epi- or transmural). Twenty-nine out of 36 (80.5%) non-endocardial CMR-channels were coincident with CT-channels. CT and CMR Channels Conclusion CT shows a modest sensitivity in identifying CMR-channels and fails in ascertain their complexity, underestimating the number of entrances; however, channels location at CT fit well with CMR for those classified as transmural or epicardial.

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Right and Left Ventricular Hemodynamic Performance During Sustained Ventricular Tachycardia

The American Journal of Cardiology ◽

10.1016/s0002-9149(96)00755-2 ◽

1997 ◽

Vol 79 (3) ◽

pp. 323-327 ◽

Cited By ~ 5

Author(s):

Theofilos M Kolettis ◽

Sanjeev Saksena ◽

Philip Mathew ◽

Ryszard B Krol ◽

Irakli Giorgberidze ◽

...

Keyword(s):

Ventricular Tachycardia ◽

Left Ventricular ◽

Sustained Ventricular Tachycardia ◽

Hemodynamic Performance

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MELAS Syndrome with Cardiac Involvement: A Multimodality Imaging Approach

Case Reports in Cardiology ◽

10.1155/2016/1490181 ◽

2016 ◽

Vol 2016 ◽

pp. 1-4 ◽

Cited By ~ 1

Author(s):

Sara Seitun ◽

Laura Massobrio ◽

Anna Rubegni ◽

Claudia Nesti ◽

Margherita Castiglione Morelli ◽

...

Keyword(s):

Lactic Acidosis ◽

Cardiac Death ◽

Ventricular Hypertrophy ◽

Cardiac Involvement ◽

Multimodality Imaging ◽

Left Ventricular ◽

Gene Diagnosis ◽

Cardioverter Defibrillator ◽

Increased Risk ◽

Imaging Approach

A 49-year-old man presented with chest pain, dyspnea, and lactic acidosis. Left ventricular hypertrophy and myocardial fibrosis were detected. The sequencing of mitochondrial genome (mtDNA) revealed the presence of A to G mtDNA point mutation at position 3243 (m.3243A>G) in tRNALeu(UUR) gene. Diagnosis of cardiac involvement in a patient with Mitochondrial Encephalomyopathy, Lactic Acidosis, and Stroke-like episodes syndrome (MELAS) was made. Due to increased risk of sudden cardiac death, cardioverter defibrillator was implanted.

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