Skip to main content
PMC home page
Clinical Cardiology logoLink to Clinical Cardiology
. 2009 Feb 3;20(10):898–903. doi: 10.1002/clc.4960201021

Postinfarction Left Ventricular Pseudoaneurysm

Kalman Csapo 1, Laszlo Voith 1, Tibor Szuk 1, Istvan Edes 1, Dean J Kereiakes 2,✉
PMCID: PMC6655895  PMID: 9377830

Abstract

Left ventricular wall rupture after myocardial infarction is a mechanical complication that may result in a pseudoaneurysm. Between January 1994 and October 1996, false or pseudoaneurysms were detected in 6 (0.0026%) of 2,600 consecutive patients (4 women, 2 men; mean age 59.4 years) undergoing cardiac catheterization at University Medical School, Debrecen, Hungary. All patients had a history of cardiovascular disease, with diagnosis of pseudoaneurysm confirmed by echocardiography. The average time from the occurrence of acute infarction to diagnosis was 37.0 days (range 3–80 days). All patients were in New York Heart Association functional class IV congestive heart failure; in four patients cardiogenic shock was present. Five patients underwent coronary angiography, which demonstrated multivessel disease and occlusion of the infarct–related artery (TIMI 0) without adequate collateral circulation (grade 0–1). Five patients had surgical repair of the false aneurysm, and, in three patients, concomitant coronary bypass grafting was performed. The 2‐year mortality rate for all patients was 50%. Early diagnosis of false aneurysm is facilitated by echocardiography, and coronary angiography is required before surgery. Early surgical correction with coronary revascularization is advised.

Keywords: pseudoaneurysm, myocardial infarction, myocardial rupture

Full Text

The Full Text of this article is available as a PDF (977.3 KB).

References

  • 1. Ivert T, Aldahl SM, Lunde P, Lindblom D: Postinfarction left ventricular pseudoaneurysm: Echocardiography diagnosis and surgical repair. Cardiovasc Surg 1994; 2: 463–466 [PubMed] [Google Scholar]
  • 2. Kuykendall M, Doherty J, Talley JD: Left ventricular pseudoaneurysm: A patient report and discussions. J Invas Cardiol 1995; 7: 115–118 [PubMed] [Google Scholar]
  • 3. Chesler E, Korns ME, Porte GE, Reyes CN, Edwards JE: False aneurysm of the left ventricle secondary to bacterial endocarditis with perforation of the mitral‐aortic intervalvular fibrosa. Circulation 1968; 37: 518–523 [DOI] [PubMed] [Google Scholar]
  • 4. Lee SJK, Ko PTH, Hendin ID, Stems LP: False left ventricular aneurysm as a complication of open heart surgery. Can Med Assoc J 1976; 115: 45–46 [PMC free article] [PubMed] [Google Scholar]
  • 5. Schwengel RH, Bennett SK, Sequeira AJ, White CS, Ziskind AA: Late presentation of left ventricular pseudoaneurysm and ventricular septal defect after surgery for penetrating cardiac injury. Am Heart J 1994; 127: 93–95 [DOI] [PubMed] [Google Scholar]
  • 6. Schlichter J, Hellerstein HK, Katz LN: Aneurysm of the heart: A correlative study of one hundred and two proved cases. Medicine 1954; 33: 43–86 [PubMed] [Google Scholar]
  • 7. Kirklin JW, Barratt‐Boyes BG. (Eds): Cardiac Surgery, p. 296 New York: John Wiley and Sons, 1986. [Google Scholar]
  • 8. Friedman MS, Kuhn IA: Clinical and electrocardiographic features of cardiac rupture following acute myocardial infarction. Am J Med 1971; 50: 709–720 [DOI] [PubMed] [Google Scholar]
  • 9. Higgins CB, Lipton MJ, Johnson AD, Peterson KL, Vieweg WVR: False aneurysm of the left ventricle. Radiology 1978; 127: 21–28 [DOI] [PubMed] [Google Scholar]
  • 10. Catherwood E, Mintz GS, Kotler MN, Parry WR, Segal BL: Two dimensional echocardiographic recognition of left ventricular pseudoaneurysm. Circulation 1980; 62: 294–303 [DOI] [PubMed] [Google Scholar]
  • 11. Stoddard MF, Dawkins PR, Longaker RA, Goad J, Shih A: Transesophageal echocardiography in detection of left ventricular pseudoaneurysm. Am Heart J 1993; 125: 534–539 [DOI] [PubMed] [Google Scholar]
  • 12. Vladover Z, Coe J, Edwards JE: True and false left ventricular aneurysm. Propensity for the latter to rupture. Circulation 1975; 51: 567–572 [DOI] [PubMed] [Google Scholar]
  • 13. Vanoverschelde JLJ, Wijns W, Depre CH, Essamri B, Heyndrickx GR, Borgers M, Bol A, Melin JA: Mechanisms of chronic regional postischemic dysfunction in humans. Circulation 1993; 87: 1513–1523 [DOI] [PubMed] [Google Scholar]
  • 14. Bates RJ, Beutler S, Resnekov L, Anagnostopoulos CE: Cardiac rupture‐challenge in diagnosis and management. Am J Cardiol 1977; 40: 429–436 [DOI] [PubMed] [Google Scholar]
  • 15. Schuster E, Bulkley B: Expansion of transmural myocardial infarction: A pathophysiologic factor in cardiac rupture. Circulation 1979; 60: 1532–1538 [DOI] [PubMed] [Google Scholar]
  • 16. Lewis A, Burchell H, Titus J: Clinical and pathologic features of post‐infarction cardiac rupture. Am J Cardiol 1969; 23: 45–54 [DOI] [PubMed] [Google Scholar]
  • 17. Nakamura F, Minamino T, Higashino Y, Ito H, Fujii K, Fujita T, Nagano M, Higaki J, Ogihara T: Cardiac free wall rupture in acute myocardial infarction: Ameliorative effect of coronary reperfusion. Clin Cardiol 1992; 15: 244–250 [DOI] [PubMed] [Google Scholar]
  • 18. Sleight P: Intravenous beta‐blocker therapy in the acute stage of myocardial infarction. Pract Cardiol 1988; 14: 84–92 [Google Scholar]
  • 19. O'Neill WW, Brodie BR, Ivanhoe R, Knopf W, Taylor G, O'Keefe J, Grines CL, Weintraub R, Sickinger BG, Berdan LG, Tcheng JE, Woodlief LH, Strzelecki M, Hartzler G, Califf RM: Primary coronary angioplasty for acute myocardial infarction (the Primary Angioplasty Registry). Am J Cardiol 1994; 73: 627–634 [DOI] [PubMed] [Google Scholar]
  • 20. Honan MB, Harrell FE Jr, Reimer KA, Califf RM, Mark DB, Pyror DB, Hlatky MA: Cardiac rupture, mortality and timing of thrombolytic therapy: A meta‐analysis. J Am Coll Cardiol 1990; 16: 359–367 [DOI] [PubMed] [Google Scholar]
  • 21. Roberts WC, Morrow AG: Pseudoaneurysm of the left ventricle. An unusual sequel of myocardial infarction and rupture of the heart. Am J Med 1967; 43: 639–644 [DOI] [PubMed] [Google Scholar]
  • 22. Chesler E: Aneurysm of the left ventricle In Cardiovascular Clinics: Clinical‐Pathologic Correlations (Ed. Edwards JE.), p. 188–217. Philadelphia: F.A. Davis Company, 1972. [Google Scholar]
  • 23. Stewart S, Huddle R, Stuard I, Schreiner BF, DeWeese JA: False aneurysm and pseudo‐false aneurysm of the left ventricle: Etiology, pathology, diagnosis and operative management. Ann Thorac Surg 1981; 31: 259–265 [DOI] [PubMed] [Google Scholar]
  • 24. Epstein Jl, Hutchins GM: Subepicardial aneurysms: A rare complication of myocardial infarction. Am J Med 1983; 75: 639–644 [DOI] [PubMed] [Google Scholar]
  • 25. Lopez‐Martinez JI: Pulsatory and auscultatory phenomena in pseudoaneurysm of the heart. Texas Heart Ins J 1994; 21: 296–303 [Google Scholar]
  • 26. Sakai K, Nakamura K, Ishizuka N, Nakagawa M, Hosoda S: Echocardiographic findings and clinical features of left ventricular pseudoaneurysm after mitral valve replacement. Am Heart J 1992; 24: 975–982 [DOI] [PubMed] [Google Scholar]
  • 27. Harrity P, Patel A, Bianco J, Subramanian R: Improved diagnosis and characterization of postinfarction left ventricular pseudoaneurysm by cardiac magnetic resonance imaging. Clin Cardiol 1991; 14: 603–606 [DOI] [PubMed] [Google Scholar]
  • 28. Zeman RK, Silverman PM, Vieco PT, Costelloa P: CT angiography. Am J Radiol 1995; 165: 1079–1088 [DOI] [PubMed] [Google Scholar]
  • 29. Botvinick EH, Shames D, Hutchinson JC, Roe BB, Fitzpatrick M: Non‐invasive diagnosis of a false left ventricular aneurysm with radioisotope gated cardiac blood pool imaging. Am J Cardiol 1976; 37: 1089–1093 [DOI] [PubMed] [Google Scholar]
  • 30. Rentrop KP, Cohen M, Blanke H, Phillips RA: Changes in collateral channel filling immediately after controlled coronary artery occlusion by angioplasty in human subjects. J Am Coll Cardiol 1985; 5: 587–592 [DOI] [PubMed] [Google Scholar]
  • 31. Topaz O, Taylor A: Interventricular septal rupture complicating acute myocardial infarction: From pathophysiologic features to the role of invasive and noninvasive diagnostic modalities in current management. Am J Med 1992; 93: 683–688 [DOI] [PubMed] [Google Scholar]
  • 32. Topaz O, DiSciascio G, Vetrovec GV: Curriculum in cardiology—acute ventricular septal rupture: Perspectives on the current role of ventriculography and coronarography and their implication for surgical repair. Am Heart J 1990; 120: 412–417 [DOI] [PubMed] [Google Scholar]
  • 33. Otto CM, Stratton JR: Postinfarction left ventricular pseudoaneurysm: Echocardiographic diagnosis and prolonged survival in three patients. Clin Cardiol 1988; 11: 189–192 [DOI] [PubMed] [Google Scholar]
  • 34. Bolognesi R, Cucchini F, Lettieri C, Manca C, Visioli O: Left ventricular false aneurysm: An unusually prolonged natural history. Cath Cardiovasc Diagn 1995; 36: 46–50 [DOI] [PubMed] [Google Scholar]

Articles from Clinical Cardiology are provided here courtesy of Wiley

RESOURCES