RESUMEN
BACKGROUND: Myocardial infarction with non-obstructive coronary arteries (MINOCA) is a rare cause of heart attack, which may not receive sufficient attention from patients during post-discharge treatment, especially among those with normal coronary angiography results. CASE PRESENTATION: We present the case of a 65-year-old woman who was readmitted to the hospital with ventricular septal rupture (VSR) complicated by ventricular aneurysm, occurring 2 weeks after myocardial infarction. During the initial admission, coronary angiography revealed normal coronary arteries, leading to a diagnosis of MINOCA. Epicardial coronary vasospasm or coronary embolism was considered as potential causes; however, the patient did not adhere to standardized treatment upon initial discharge. The delayed VSR led to a decline in cardiac function but did not result in severe hemodynamic impairment. Following correction of heart failure with medications, the patient underwent percutaneous VSR repair 19 days after diagnosis and was discharged with a favorable recovery. CONCLUSIONS: The occurrence of delayed VSR complicated with ventricular aneurysm in patients with MINOCA is rare, highlighting the possibility of serious complications in MINOCA cases. Both cardioprotective therapies and cause-targeted therapies are essential in the management of patients with MINOCA.
Asunto(s)
Angiografía Coronaria , Aneurisma Cardíaco , Rotura Septal Ventricular , Humanos , Femenino , Anciano , Rotura Septal Ventricular/etiología , Rotura Septal Ventricular/fisiopatología , Rotura Septal Ventricular/diagnóstico por imagen , Rotura Septal Ventricular/diagnóstico , Aneurisma Cardíaco/diagnóstico por imagen , Aneurisma Cardíaco/fisiopatología , Aneurisma Cardíaco/etiología , Aneurisma Cardíaco/complicaciones , Resultado del Tratamiento , Factores de TiempoRESUMEN
Background and Objectives. Distinct pressure curve differences exist between akinetic (A-LVA) and dyskinetic (D-LVA) aneurysms. In D-LVA, left ventricular (LV) ejection pressure decreases relative to the aneurysm size, whereas A-LVA does not impact pressure curves, indicating that the decrease in stroke volume (SV) and cardiac output is proportional to the size of dyskinesia. This study aimed to assess the frequency of A-LVA and D-LVA, determine aneurysm size parameters (volume and surface area), and evaluate predictive parameters using echocardiography in A-LVA and D-LVA. Furthermore, it aimed to compare individual echocardiographic parameters, according to ejection fraction (EF) and SV, with hemodynamic events shown in experimental models of A-LVA and D-LVA and their significance in everyday clinical practice. Materials and Methods. This clinical study included patients with post-infarction left ventricular aneurysm (LVA) admitted to the cardiovascular institute ''Dedinje", Serbia. Echocardiographic volume and surface area of LV and LVA were determined (by the area-length method) along with EF (by Simpson's method). Results. A-LVA was present in 62.9% of patients, while D-LVA was present in 37.1%. Patients with D-LVA had significantly higher systolic aneurysm volume (LVAVs) (94.07 ± 74.66 vs. 51.54 ± 53.09, p = 0.009), systolic aneurysm surface area (LVAAs) (23.22 ± 11.73 vs. 16.41 ± 8.58, p = 0.018), and end-systolic left ventricular surface areas (LVESA) (50.79 ± 13.33 vs. 42.76 ± 14.11, p = 0.045) compared to patients with A-LVA. The ratio of LVA volume to LV volume was higher in the D-LVA in systole (LVAVs/LVESV). The end-diastolic volume of LV (LVEDV) and end-systolic volume of LV (LVESV) did not significantly differ between D-LVA and A-LVA. EF (21.25 ± 11.92 vs. 28.18 ± 11.91, p = 0.044) was significantly lower among patients with D-LVA. Conclusions. Differentiating between A-LVA and D-LVA using echocardiography is crucial since D-LVA causes greater hemodynamic disturbances in LV function, and thus surgical resection of the aneurysm or LV reconstruction must have a positive effect regardless of myocardial revascularization surgery.
Asunto(s)
Ecocardiografía , Aneurisma Cardíaco , Ventrículos Cardíacos , Volumen Sistólico , Humanos , Masculino , Femenino , Aneurisma Cardíaco/fisiopatología , Aneurisma Cardíaco/diagnóstico por imagen , Aneurisma Cardíaco/complicaciones , Ecocardiografía/métodos , Persona de Mediana Edad , Anciano , Volumen Sistólico/fisiología , Ventrículos Cardíacos/diagnóstico por imagen , Ventrículos Cardíacos/fisiopatologíaRESUMEN
OBJECTIVE: In this study, we explored the determinants of ventricular aneurysm development following acute myocardial infarction (AMI), thereby prompting timely interventions to enhance patient prognosis. METHODS: In this retrospective cohort analysis, we evaluated 297 AMI patients admitted to the First People's Hospital of Changzhou. The study was structured as follows. Comprehensive baseline data collection included hematological evaluations, ECG, echocardiography, and coronary angiography upon admission. Within 3 months post-AMI, cardiac ultrasounds were administered to detect ventricular aneurysm development. Univariate and multivariate logistic regression analysis were employed to pinpoint the determinants of ventricular aneurysm formation. Subsequently, a predictive model was formulated for ventricular aneurysm post-AMI. Moreover, the diagnostic efficacy of this model was appraised using the ROC curves. RESULTS: In our analysis of 291 AMI patients, spanning an age range of 32-91 years, 247 were male (84.9%). At the conclusion of a 3-month observational period, the cohort bifurcated into two subsets: 278 patients without ventricular aneurysm and 13 with evident ventricular aneurysm. Distinguishing features of the ventricular aneurysm subgroup were markedly higher values for age, B-type natriuretic peptide(BNP), Left atrium(LA), Left ventricular end-diastolic dimension (LEVDD), left ventricular end systolic diameter (LVEWD), E-wave velocity (E), Left atrial volume (LAV), E/A ratio (E/A), E/e ratio (E/e), ECG with elevated adjacent four leads(4 ST-Elevation), and anterior wall myocardial infarction(AWMI) compared to their counterparts (p < 0.05). Among the singular predictive factors, total cholesterol (TC) emerged as the most significant predictor for ventricular aneurysm development, exhibiting an AUC of 0.704. However, upon crafting a multifactorial model that incorporated gender, TC, an elevated ST-segment in adjacent four leads, and anterior wall infarction, its diagnostic capability: notably surpassed that of the standalone TC, yielding an AUC of 0.883 (z = -9.405, p = 0.000) as opposed to 0.704. Multivariate predictive model included gender, total cholesterol, ST elevation in 4 adjacent leads, anterior myocardial infarction, the multivariate predictive model showed better diagnostic efficacy than single factor index TC (AUC: 0. 883 vs. 0.704,z =-9.405, p = 0.000), it also improved predictive power for correctly reclassifying ventricular aneurysm occurrence in patients with AMI, NRI = 28.42% (95% CI: 6.29-50.55%; p = 0.012). Decision curve analysis showed that the use of combination model had a positive net benefit. CONCLUSION: Lipid combined with ECG model after myocardial infarction could be used to predict the formation of ventricular aneurysm and aimed to optimize and adjust treatment strategies.
Asunto(s)
Aneurisma Cardíaco , Infarto del Miocardio , Valor Predictivo de las Pruebas , Humanos , Masculino , Femenino , Persona de Mediana Edad , Aneurisma Cardíaco/diagnóstico por imagen , Aneurisma Cardíaco/fisiopatología , Estudios Retrospectivos , Anciano , Adulto , Anciano de 80 o más Años , Factores de Riesgo , Infarto del Miocardio/diagnóstico , Infarto del Miocardio/diagnóstico por imagen , Infarto del Miocardio/fisiopatología , Pronóstico , Medición de Riesgo , Factores de Tiempo , China/epidemiología , Ventrículos Cardíacos/diagnóstico por imagen , Ventrículos Cardíacos/fisiopatología , Electrocardiografía , Infarto del Miocardio con Elevación del ST/diagnóstico , Infarto del Miocardio con Elevación del ST/diagnóstico por imagen , Infarto del Miocardio con Elevación del ST/fisiopatología , Infarto del Miocardio con Elevación del ST/terapia , Infarto del Miocardio con Elevación del ST/complicacionesRESUMEN
The most common mechanical complications of acute myocardial infarction include free-wall rupture, ventricular septal rupture (VSR), papillary muscle rupture and pseudoaneurysm. It is rare for a patient to experience more than one mechanical complication simultaneously. Here, we present a case of ST-segment elevation myocardial infarction (STEMI) complicated with three mechanical complications, including ventricular apical wall rupture, ventricular aneurysm formation and ventricular septal dissection (VSD) with VSR. Cardiac auscultation revealed rhythmic S1 and S2 with a grade 3 holosystolic murmur at the left sternal border. Electrocardiogram indicated anterior ventricular STEMI. Serological tests showed a significant elevated troponin I. Bedside echocardiography revealed ventricular apical wall rupture, apical left ventricle aneurysm and VSD with VSR near the apex. This case demonstrates that several rare mechanical complications can occur simultaneously secondary to STEMI and highlights the importance of bedside echocardiography in the early diagnosis of mechanical complications.
Asunto(s)
Aneurisma Cardíaco , Rotura Cardíaca Posinfarto , Infarto del Miocardio con Elevación del ST , Rotura Septal Ventricular , Anciano , Humanos , Electrocardiografía , Aneurisma Cardíaco/diagnóstico por imagen , Aneurisma Cardíaco/etiología , Aneurisma Cardíaco/complicaciones , Aneurisma Cardíaco/fisiopatología , Rotura Cardíaca Posinfarto/etiología , Rotura Cardíaca Posinfarto/diagnóstico por imagen , Rotura Cardíaca Posinfarto/diagnóstico , Pruebas en el Punto de Atención , Valor Predictivo de las Pruebas , Infarto del Miocardio con Elevación del ST/etiología , Infarto del Miocardio con Elevación del ST/diagnóstico , Infarto del Miocardio con Elevación del ST/complicaciones , Infarto del Miocardio con Elevación del ST/terapia , Infarto del Miocardio con Elevación del ST/fisiopatología , Infarto del Miocardio con Elevación del ST/diagnóstico por imagen , Resultado del Tratamiento , Rotura Septal Ventricular/etiología , Rotura Septal Ventricular/diagnóstico por imagen , Rotura Septal Ventricular/fisiopatología , Rotura Septal Ventricular/diagnóstico , Rotura Septal Ventricular/cirugía , FemeninoRESUMEN
The association between cryptogenic stroke (CS) and patent foramen ovale (PFO) with or without atrial septal aneurysm (ASA) has been a debate for decades in terms of pathophysiologic processes and clinical courses. This issue has become more interesting and complex, because of the concerns associating the CS with so-called normal variant pathologies of interatrial septum, namely ASA and PFO. While there is an anatomical pathology in the interatrial septum, namely PFO and ASA, the embolic source of stroke is not clearly defined. Moreover, in patients with PFO and CS, the risk of recurrent stroke has also been associated with other PFOunrelated factors, such as hyperlipidemia, body mass index, diabetes mellitus, and hypertension, leading to the difficulty in understanding the pathophysiologic mechanism of CS in patients with PFO and/or ASA. Theoretically, the embolic source of cryptogenic stroke in which PFO and/or ASA has been involved can be categorized into three different anatomical locations, namely PFO tissue and/or ASA tissue itself, right or left atrial chambers, and venous vascular territory distal to the right atrium, i.e., inferior vena cava and lower extremity venous system. However, the possible role of paroxysmal atrial fibrillation associated with PFO and/or ASA as a source of cryptogenic stroke has never been mentioned clearly in the literature. This review aims to explain the association of cryptogenic stroke with PFO and/or ASA in a comprehensive manner, including anatomical, clinical, and mechanistic aspects. The potential role of paroxysmal atrial fibrillation and its contribution to clinical course have been also discussed in a hypothetical manner to elucidate the pathophysiology of CS and support further treatment modalities.
Asunto(s)
Fibrilación Atrial , Foramen Oval Permeable , Aneurisma Cardíaco , Humanos , Foramen Oval Permeable/complicaciones , Foramen Oval Permeable/fisiopatología , Fibrilación Atrial/fisiopatología , Fibrilación Atrial/etiología , Fibrilación Atrial/complicaciones , Aneurisma Cardíaco/fisiopatología , Aneurisma Cardíaco/etiología , Aneurisma Cardíaco/complicaciones , Factores de Riesgo , Accidente Cerebrovascular Isquémico/etiología , Accidente Cerebrovascular Isquémico/fisiopatología , Tabique Interatrial/fisiopatologíaRESUMEN
AIMS: Due to its low incidence, poor prognosis, and high mortality in the acute phase, the long-term prognosis of the left ventricular aneurysm (LVA) complicated by ventricular septal rupture (VSR) has received little attention. This study focus on the long-term prognosis of patients with LVA complicated by relatively stable VSR. METHODS AND RESULTS: Over a decade of retrospection, 68 patients with both LVA and VSR were compared with 136 patients with LVA alone after propensity score matching. Patients with both LVA and VSR were further divided into two groups depending on whether pre-operative intra-aortic balloon pump (IABP) was used (23 pre-operative IABP vs. 45 non-pre-operative IABP). The primary endpoint was defined as major adverse cardiovascular and cerebrovascular events, a composite endpoint including mortality, myocardial infarction, revascularization, stroke, and heart failure. Patients with both LVA and VSR were generally in a worse condition upon admission compared with those with LVA alone [percentage of patients in New York Heart Association IV: 42.6% (29/68) vs. 11.0% (15/136), P < 0.001]. Both pre-operative and post-operative IABP use rates were significantly higher in patients with both LVA and VSR than in patients with LVA alone [pre-operative IABP use rates: 33.8% (23/68) vs. 0.74% (1/136), P < 0.001 and post-operative IABP use rates: 33.8% (23/68) vs. 10.3% (14/136), P < 0.001]. No significant difference was observed in the primary endpoint between patients with both LVA and VSR and those with LVA alone (log-rank test, P = 0.63, median follow-up time 63 months). We further investigated the effect of pre-operative IABP on the long-term prognosis of patients with both LVA and VSR. Patients who applied pre-operative IABP had a worse long-term prognosis than those who did not (log-rank test, P = 0.0011). CONCLUSIONS: The long-term prognosis of LVA combined with VSR was not inferior than LVA alone after surgery, but poor blood perfusion status was associated with a worse prognosis.
Asunto(s)
Aneurisma Cardíaco , Ventrículos Cardíacos , Contrapulsador Intraaórtico , Rotura Septal Ventricular , Humanos , Masculino , Femenino , Pronóstico , Rotura Septal Ventricular/etiología , Rotura Septal Ventricular/diagnóstico , Estudios Retrospectivos , Aneurisma Cardíaco/diagnóstico , Aneurisma Cardíaco/complicaciones , Aneurisma Cardíaco/fisiopatología , Aneurisma Cardíaco/etiología , Anciano , Ventrículos Cardíacos/fisiopatología , Ventrículos Cardíacos/diagnóstico por imagen , Contrapulsador Intraaórtico/métodos , Estudios de Seguimiento , Persona de Mediana Edad , Tasa de Supervivencia/tendencias , Puntaje de PropensiónAsunto(s)
Arritmias Cardíacas/etiología , Apéndice Atrial/diagnóstico por imagen , Apéndice Atrial/fisiopatología , Aneurisma Cardíaco/diagnóstico , Aneurisma Cardíaco/fisiopatología , Síncope/etiología , Adulto , Arritmias Cardíacas/fisiopatología , Arritmias Cardíacas/cirugía , Apéndice Atrial/cirugía , Electrocardiografía/métodos , Estudios de Seguimiento , Aneurisma Cardíaco/cirugía , Humanos , Imagen por Resonancia Magnética/métodos , Masculino , Síncope/fisiopatología , Síncope/cirugíaRESUMEN
BACKGROUND: Malformation of the right atrium is a rare cardiac abnormality and is usually reported as isolated malformation in the literature. CASE PRESENTATION: Prenatal giant atrial dilatation in an asymptomatic infant was treated surgically at 18 months of age, due to potential risk of thrombosis and arrhythmias. Post-surgical echocardiographic images illustrate residual atrial elevated pressure. CONCLUSIONS: Sometimes, as seems in our case, right atrial dilatation hides an associated restrictive right ventricle.
Asunto(s)
Cardiomegalia/etiología , Aneurisma Cardíaco/congénito , Atrios Cardíacos/anomalías , Cardiopatías Congénitas/complicaciones , Función del Atrio Derecho , Presión Atrial , Cardiomegalia/diagnóstico por imagen , Cardiomegalia/fisiopatología , Cardiomegalia/cirugía , Ecocardiografía , Femenino , Aneurisma Cardíaco/diagnóstico por imagen , Aneurisma Cardíaco/fisiopatología , Aneurisma Cardíaco/cirugía , Atrios Cardíacos/diagnóstico por imagen , Atrios Cardíacos/fisiopatología , Atrios Cardíacos/cirugía , Cardiopatías Congénitas/diagnóstico por imagen , Cardiopatías Congénitas/fisiopatología , Cardiopatías Congénitas/cirugía , Humanos , Lactante , Recién Nacido , Imagen por Resonancia Magnética , Embarazo , Resultado del Tratamiento , Ultrasonografía Prenatal , Función Ventricular DerechaRESUMEN
BACKGROUND: Ventricular arrhythmia is a leading cause of cardiac death among patients with post-infarction left ventricular aneurysm (PI-LVA). The effect of coronary revascularization in PI-LVA patients with ventricular tachyarrhythmia remains unknown. This study aims to investigate the impact of revascularization therapy on clinical outcomes in these patients. METHODS: A total of 238 PI-LVA patients were enrolled, and 59 patients were presented with sustained ventricular tachycardia (VT) or ventricular fibrillation (VF). Patients were classified into 4 groups by treatment strategies (medical or revascularization) and the presence of VT/VF: group 1 (n = 57): VT/VF- and revascularization-; group 2 (n = 122): VT/VF- and revascularization+; group 3 (n = 34): VT/VF+ and revascularization+; and group 4 (n = 25): VT/VF+ and revascularization-. The clinical outcomes were compared, and the primary endpoint was cardiac death or heart transplantation. RESULTS: Patients were followed up for 45 ± 16 months, and 41 patients (17.2%) reached the primary endpoint. Kaplan-Meier analysis showed that in VT/VF- patients, revascularization associated with higher cardiac survival compared with medical therapy (log-rank p = .002), but in VT/VF+ patients, revascularization did not predict better cardiac outcome (log-rank p = .901). Cox regression analysis revealed PET-EF (HR 4.41, 95% CI: 1.72-11.36, p = .002) and moderate/severe mitral regurgitation (HR 2.32, 95% CI: 1.02-5.30, p = .046) as independent predictors of adverse cardiac outcome in patients with VT/VF. CONCLUSION: PI-LVA patients with VT/VF are at high risk of adverse cardiac outcome, and coronary revascularization does not mitigate this risk, although revascularization was associated with higher cardiac survival in PI-LVA patients without VT/VF.
Asunto(s)
Puente de Arteria Coronaria/métodos , Aneurisma Cardíaco/cirugía , Infarto del Miocardio/complicaciones , Intervención Coronaria Percutánea/métodos , Taquicardia Ventricular/cirugía , Femenino , Estudios de Seguimiento , Aneurisma Cardíaco/etiología , Aneurisma Cardíaco/fisiopatología , Humanos , Estimación de Kaplan-Meier , Masculino , Persona de Mediana Edad , Infarto del Miocardio/fisiopatología , Taquicardia Ventricular/etiología , Taquicardia Ventricular/fisiopatologíaRESUMEN
Surgical ventricular reconstruction is a proven option for treating patients who have heart failure due to a postinfarction scar or an aneurysm of the left ventricle. The BioVentrix Revivent TC System offers a reliable alternative to the conventional, more invasive surgical ventricular restoration. The system requires no sternotomy, no heart-lung machine, and no cardioplegic arrest. In this video tutorial, we present our technique for using the Revivent TC System to reconstruct the normal left ventricular shape and volume in a patient with a postinfarction, anteroapical scar.
Asunto(s)
Procedimientos Quirúrgicos Cardíacos/métodos , Cicatriz/cirugía , Aneurisma Cardíaco/cirugía , Ventrículos Cardíacos , Infarto del Miocardio/complicaciones , Cicatriz/diagnóstico por imagen , Cicatriz/etiología , Femenino , Aneurisma Cardíaco/etiología , Aneurisma Cardíaco/fisiopatología , Insuficiencia Cardíaca/etiología , Insuficiencia Cardíaca/cirugía , Ventrículos Cardíacos/diagnóstico por imagen , Ventrículos Cardíacos/patología , Ventrículos Cardíacos/fisiopatología , Ventrículos Cardíacos/cirugía , Humanos , Persona de Mediana Edad , Procedimientos de Cirugía Plástica/métodos , Resultado del TratamientoRESUMEN
BACKGROUND: It is still controversial which left ventricular aneurysm repair technique is optimal in terms of early and late results. This study aimed to compare early postoperative outcomes for 2 surgical treatments of postinfarction left ventricular aneurysm: linear repair technique on arrested heart versus endoaneurysmorrhaphy repair with patch plasty on beating heart. METHODS: Prospectively collected data from 16 consecutive patients who underwent endoaneurysmorrhaphy repair with patch plasty on beating heart (the technique we have preferred since 2008) were compared with data from a retrospective series of 10 patients who underwent linear repair on arrested heart (the technique we preferred until 2008). All operations were performed under elective conditions. RESULTS: Baseline characteristics of the 2 groups were similar. Complete revascularization for all diseased vessels was achieved in all patients. Durations of cross clamping, cardiopulmonary bypass, intensive care stay, and hospital stay were longer, and postoperative ejection fraction was lower, in the linear repair group compared with the endoaneurysmorrhaphy group (P < .05 for all). Early mortality occurred in 1 patient (3.8%) in the linear repair group. CONCLUSION: Endoaneurysmorrhaphy repair with patch plasty on beating heart seems to offer advantages over the linear repair technique on arrested heart in the treatment of left ventricular aneurysms. Future large-scale prospective studies with longer follow-up are warranted to draw firm conclusions.
Asunto(s)
Procedimientos Quirúrgicos Cardíacos/métodos , Aneurisma Cardíaco/cirugía , Paro Cardíaco Inducido/métodos , Función Ventricular Izquierda/fisiología , Anciano , Puente Cardiopulmonar/métodos , Femenino , Estudios de Seguimiento , Aneurisma Cardíaco/fisiopatología , Ventrículos Cardíacos/fisiopatología , Ventrículos Cardíacos/cirugía , Humanos , Masculino , Estudios Retrospectivos , Factores de Tiempo , Resultado del TratamientoAsunto(s)
Aneurisma Falso/etiología , Infarto de la Pared Anterior del Miocardio/complicaciones , Aneurisma Cardíaco/etiología , Rotura Septal Ventricular/etiología , Anciano , Aneurisma Falso/diagnóstico por imagen , Aneurisma Falso/fisiopatología , Aneurisma Falso/terapia , Infarto de la Pared Anterior del Miocardio/diagnóstico por imagen , Cateterismo Cardíaco/instrumentación , Femenino , Aneurisma Cardíaco/diagnóstico por imagen , Aneurisma Cardíaco/fisiopatología , Aneurisma Cardíaco/terapia , Humanos , Resultado del Tratamiento , Rotura Septal Ventricular/diagnóstico por imagen , Rotura Septal Ventricular/fisiopatología , Rotura Septal Ventricular/terapiaAsunto(s)
Electrocardiografía , Aneurisma Cardíaco , Infarto del Miocardio , Aneurisma Cardíaco/diagnóstico , Aneurisma Cardíaco/etiología , Aneurisma Cardíaco/fisiopatología , Humanos , Masculino , Persona de Mediana Edad , Infarto del Miocardio/complicaciones , Infarto del Miocardio/diagnóstico , Infarto del Miocardio/fisiopatologíaRESUMEN
BACKGROUND: There are a variety of causes of left ventricular aneurysm, but it is rarely due to a disturbance in intraventricular hemodynamics. To the best of our knowledge, there have been no reports of ventricular aneurysm at the left ventricular apex caused by an abnormal left ventricular muscle bundle. CASE PRESENTATION: We report two cases of patients with congenital abnormal left ventricular muscle bundles which caused disturbances in intraventricular hemodynamics. This process eventually led to a left ventricular aneurysm at the apex of the heart. In both cases, transthoracic echocardiography (TTE) and cardiac magnetic resonance imaging (CMR) indicated ventricular aneurysm formation at the apex of the left ventricle. There were also abnormal muscular bundles connecting the ventricular septum and the posterior wall of the left ventricle. The only differences between these two cases were the comorbidities and severity of symptoms. CONCLUSION: Ventricular aneurysm at the apex of the left ventricle is common. However, it is rare for a ventricular aneurysm to form due to intraventricular hemodynamic disturbances caused by an abnormal muscle bundle as opposed to that due to original ventricular wall damage, which is more common. There is currently a lack of relevant studies on the treatment and prognosis of such patients. Whether surgical resection of a ventricular aneurysm leads to a better prognosis remains uncertain.
Asunto(s)
Circulación Coronaria , Aneurisma Cardíaco/etiología , Cardiopatías Congénitas/complicaciones , Hemodinámica , Músculos Papilares/anomalías , Función Ventricular Izquierda , Adulto , Anciano , Anticoagulantes/uso terapéutico , Procedimientos Quirúrgicos Cardíacos , Femenino , Aneurisma Cardíaco/diagnóstico por imagen , Aneurisma Cardíaco/fisiopatología , Aneurisma Cardíaco/terapia , Cardiopatías Congénitas/diagnóstico por imagen , Cardiopatías Congénitas/fisiopatología , Cardiopatías Congénitas/terapia , Humanos , Masculino , Músculos Papilares/diagnóstico por imagen , Músculos Papilares/fisiopatología , Músculos Papilares/cirugía , Resultado del TratamientoRESUMEN
Pseudoaneurysm (PSA) of the right ventricular outflow tract (RVOT) is an exceedingly rare adverse event after the surgical reconstruction of the RVOT for the treatment of congenital heart disease. We report an unusual giant PSA of RVOT in a 20-month-old child, who underwent correction of the tetralogy of Fallot. Her main symptoms were in the respiratory system, and chest X-ray also revealed the giant space-occupying lesion in the chest, which could've been misdiagnosed as a respiratory disease. After evaluation by the combination of echocardiography and cardiac computer tomography angiogram, the details of PSA were diagnosed, and surgical but not percutaneous intervention was selected. The exclusion of PSA successfully was performed by the femoral cannulation, exploratory through right ventriculotomy, closure of the defect using the Gore-Tex patch, and application of a retained drainage-tube inside the PSA.
Asunto(s)
Aneurisma Falso/diagnóstico , Procedimientos Quirúrgicos Cardíacos/métodos , Ecocardiografía Transesofágica/métodos , Aneurisma Cardíaco/diagnóstico , Ventrículos Cardíacos/diagnóstico por imagen , Radiografía Torácica/métodos , Tomografía Computarizada por Rayos X/métodos , Aneurisma Falso/fisiopatología , Aneurisma Falso/cirugía , Diagnóstico Diferencial , Femenino , Aneurisma Cardíaco/fisiopatología , Aneurisma Cardíaco/cirugía , Ventrículos Cardíacos/fisiopatología , Ventrículos Cardíacos/cirugía , Humanos , Lactante , Función Ventricular Derecha/fisiologíaAsunto(s)
Aneurisma Falso/etiología , Endocarditis Bacteriana/etiología , Aneurisma Cardíaco/etiología , Rotura Cardíaca Posinfarto/etiología , Infarto del Miocardio/etiología , Infecciones Estafilocócicas/etiología , Abuso de Sustancias por Vía Intravenosa/complicaciones , Adulto , Aneurisma Falso/diagnóstico , Aneurisma Falso/fisiopatología , Aneurisma Falso/cirugía , Endocarditis Bacteriana/diagnóstico , Endocarditis Bacteriana/fisiopatología , Endocarditis Bacteriana/cirugía , Femenino , Aneurisma Cardíaco/diagnóstico , Aneurisma Cardíaco/fisiopatología , Aneurisma Cardíaco/cirugía , Rotura Cardíaca Posinfarto/diagnóstico , Rotura Cardíaca Posinfarto/fisiopatología , Rotura Cardíaca Posinfarto/cirugía , Hemodinámica , Humanos , Infarto del Miocardio/diagnóstico , Infarto del Miocardio/fisiopatología , Infarto del Miocardio/cirugía , Recuperación de la Función , Infecciones Estafilocócicas/diagnóstico , Infecciones Estafilocócicas/fisiopatología , Infecciones Estafilocócicas/cirugía , Resultado del Tratamiento , Función Ventricular IzquierdaAsunto(s)
Aneurisma Falso/diagnóstico por imagen , Ecocardiografía , Aneurisma Cardíaco/diagnóstico por imagen , Ventrículos Cardíacos/diagnóstico por imagen , Imagen por Resonancia Magnética , Adulto , Aneurisma Falso/fisiopatología , Diagnóstico Diferencial , Aneurisma Cardíaco/fisiopatología , Ventrículos Cardíacos/fisiopatología , Humanos , Masculino , Valor Predictivo de las Pruebas , Función Ventricular IzquierdaAsunto(s)
Angiografía por Tomografía Computarizada/métodos , Aneurisma Cardíaco/diagnóstico por imagen , Válvula Mitral/diagnóstico por imagen , Adulto , Aneurisma Cardíaco/complicaciones , Aneurisma Cardíaco/fisiopatología , Humanos , Masculino , Válvula Mitral/fisiopatología , Insuficiencia de la Válvula Mitral/etiología , Insuficiencia de la Válvula Mitral/fisiopatologíaAsunto(s)
Procedimientos Quirúrgicos Cardíacos , Aneurisma Cardíaco , Insuficiencia Cardíaca , Insuficiencia de la Válvula Mitral , Válvula Mitral , Dispositivo Oclusor Septal , Cateterismo Cardíaco/métodos , Procedimientos Quirúrgicos Cardíacos/instrumentación , Procedimientos Quirúrgicos Cardíacos/métodos , Descompresión Quirúrgica/métodos , Ecocardiografía Transesofágica/métodos , Aneurisma Cardíaco/diagnóstico por imagen , Aneurisma Cardíaco/etiología , Aneurisma Cardíaco/fisiopatología , Aneurisma Cardíaco/cirugía , Insuficiencia Cardíaca/diagnóstico , Insuficiencia Cardíaca/etiología , Insuficiencia Cardíaca/cirugía , Humanos , Infarto de la Pared Inferior del Miocardio/complicaciones , Masculino , Persona de Mediana Edad , Válvula Mitral/fisiopatología , Válvula Mitral/cirugía , Insuficiencia de la Válvula Mitral/diagnóstico , Insuficiencia de la Válvula Mitral/etiología , Insuficiencia de la Válvula Mitral/fisiopatología , Cirugía Asistida por Computador/métodos , Resultado del TratamientoRESUMEN
BACKGROUND: Most of congenital ventricular septal defects evolve towards spontaneous closure of different mechanisms depending on their location. AIM: To determine the prevalence and factors associated with spontaneous closure of congenital ventricular septal defects. METHODS: We conducted a retrospective study of 1000 patients diagnosed with congenital ventricular septal defects in our department from January 2000 to December 2017. RESULTS: After an average follow-up of 52.65 months (± 76.93 months), 183 (18.88%) of ventricular septal defects closed spontaneously. The average time for spontaneous closure was 45.78 months (76.34 months). 30.77% of trabecular ventricular septal defects (p<0.05) and 16.93% of perimembranous defects closed spontaneously (p=0.17). 28.5% of perimembranous defects associated with aneurysm formation versus 17.4% of those without associated aneurysm evolved to spontaneous closure (p<0.05). 65.6% of spontaneous closure occured during the first 3 years of life. In multivariate analysis, trabecular site [OR=2.85; CI (2.05-3.97)] and aneurysms of membranous septum [OR=1.9; CI (1.41-2.8)] were independent factors associated with spontaneous closure of defects. CONCLUSION: The highest VSD closure rate was observed during the first three years of life. Trabecular site and aneurysms tissue of membranous septum were found as independent factors associated with spontaneous closure.