ABSTRACT
Congenital ventricular aneurysms (CVA) are rare cardiac anomalies that have been predominantly described in the Black population. They are characterized by an akinetic ventricular protrusion that is commonly located at the basal and apical segments. Although the diagnosis is often incidental and the majority of patients are asymptomatic, life-threatening events such as persistent ventricular arrhythmias, CVA rupture, and heart failure are not uncommon. However, no standardized therapy is currently available and good outcomes have been reported with both conservative and surgical management. We report the cases of two young Black African patients with huge symptomatic CVA lesions who underwent successful surgical repair with a ventricular restoration technique. Both cases were consulted for chest pain and dyspnea. Chest X-ray and transthoracic Doppler echocardiography suggested the diagnosis. Thoracic angioscanner and thoracic magnetic resonance imaging confirmed the diagnosis. Both patients underwent successful surgery. This case report aims to revisit the diagnostic and therapeutic approach to this rare pathology, in our professional environment.
Subject(s)
Chest Pain , Heart Aneurysm , Heart Ventricles , Magnetic Resonance Imaging , Adult , Female , Humans , Male , Young Adult , Black People , Chest Pain/etiology , Dyspnea/etiology , Echocardiography, Doppler , Heart Aneurysm/surgery , Heart Aneurysm/congenital , Heart Aneurysm/diagnosis , Heart Aneurysm/diagnostic imaging , Heart Ventricles/diagnostic imaging , Africa South of the SaharaABSTRACT
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.
Subject(s)
Echocardiography , Heart Aneurysm , Heart Ventricles , Stroke Volume , Humans , Male , Female , Heart Aneurysm/physiopathology , Heart Aneurysm/diagnostic imaging , Heart Aneurysm/complications , Echocardiography/methods , Middle Aged , Aged , Stroke Volume/physiology , Heart Ventricles/diagnostic imaging , Heart Ventricles/physiopathologyABSTRACT
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.
Subject(s)
Heart Aneurysm , Myocardial Infarction , Predictive Value of Tests , Humans , Male , Female , Middle Aged , Heart Aneurysm/diagnostic imaging , Heart Aneurysm/physiopathology , Retrospective Studies , Aged , Adult , Aged, 80 and over , Risk Factors , Myocardial Infarction/diagnosis , Myocardial Infarction/diagnostic imaging , Myocardial Infarction/physiopathology , Prognosis , Risk Assessment , Time Factors , China/epidemiology , Heart Ventricles/diagnostic imaging , Heart Ventricles/physiopathology , Electrocardiography , ST Elevation Myocardial Infarction/diagnosis , ST Elevation Myocardial Infarction/diagnostic imaging , ST Elevation Myocardial Infarction/physiopathology , ST Elevation Myocardial Infarction/therapy , ST Elevation Myocardial Infarction/complicationsABSTRACT
A 66-year-old man developed exertional dyspnea. The patient had undergone total arch replacement for a dissecting aortic arch aneurysm at the age of 53 and conservative treatment for myocardial infarction at the age of 60. Several imaging studies revealed a giant pseudoaneurysm that likely originated from a true ventricular aneurysm. The pseudoaneurysm severely compressed the right ventricle. Surgery was promptly performed. The patient had a history of cardiac surgery and had exclusively dense pericardium adhesion. Therefore, we incised the pseudoaneurysm and sutured the rupture orifice directly from inside the pseudoaneurysm under rapid pacing. This approach may represent an effective surgical alternative in patients with small rupture orifice and dense adhesions.
Subject(s)
Aneurysm, False , Heart Aneurysm , Heart Ventricles , Humans , Male , Aneurysm, False/surgery , Aneurysm, False/diagnostic imaging , Aneurysm, False/complications , Aged , Heart Aneurysm/surgery , Heart Aneurysm/diagnostic imaging , Heart Ventricles/surgery , Tomography, X-Ray ComputedABSTRACT
BACKGROUND: Left atrial appendage aneurysm is a rare cardiac mass, with only a few cases reported. There are usually no specific symptoms, and a few patients visit the doctor with symptoms. CASE PRESENTATION: A 20-year-old male presented to our hospital with a "pericardial cyst found by medical evaluation in another hospital for 2 years." Cardiac ultrasound performed at clinics of our hospital suggested a cystic dark area in the left ventricular lateral wall and the anterior lateral wall, consistent with a pericardial cyst and mild mitral regurgitation. After further relevant examinations and ruling out contraindications, an excision of the left atrial appendage aneurysm was performed under general anesthesia and cardiopulmonary bypass with beating-heart. The postoperative pathological results identified that: (left atrial appendage) fibrocystic wall-like tissue with a focal lining of the flat epithelium, consistent with a benign cyst. CONCLUSION: Left atrial appendage aneurysms are rare and insidious. They are usually found by chance during medical evaluations. If the location is not good or the volume is too large, then compression symptoms or arrhythmia, thrombosis and other concomitant symptoms will occur. Surgical resection is presently the only effective radical cure for a left atrial appendage aneurysm.
Subject(s)
Atrial Appendage , Heart Aneurysm , Humans , Male , Atrial Appendage/surgery , Atrial Appendage/diagnostic imaging , Atrial Appendage/pathology , Heart Aneurysm/surgery , Heart Aneurysm/diagnostic imaging , Heart Aneurysm/diagnosis , Young Adult , Echocardiography , Cardiac Surgical Procedures/methodsABSTRACT
Aortic root pseudoaneurysm is a devastating complication post aortic valve replacement with a high mortality rate. And dissecting aneurysm into the interventricular septum is a rare variant of aortic root pseudoaneurysm, which is scarcely reported. Multimodal imaging is of great value in its diagnosis and differential diagnosis.
Subject(s)
Aneurysm, False , Aortic Dissection , Multimodal Imaging , Ventricular Septum , Humans , Aneurysm, False/diagnostic imaging , Aneurysm, False/complications , Multimodal Imaging/methods , Ventricular Septum/diagnostic imaging , Aortic Dissection/complications , Aortic Dissection/diagnostic imaging , Aortic Dissection/diagnosis , Heart Aneurysm/etiology , Heart Aneurysm/diagnostic imaging , Heart Aneurysm/complications , Diagnosis, Differential , Male , Aortic Valve/diagnostic imaging , Echocardiography/methods , Heart Valve Prosthesis ImplantationABSTRACT
We describe the echocardiographic features of a 22-year-old female with a giant aneurysm of membranous ventricular septum (AMVS). Both transthoracic echocardiography (TTE) and transesophageal echocardiography (TEE) demonstrated significant dilatation of the aortic annulus and severe aortic regurgitation. A giant aneurysm was detected extending from a large membranous ventricular septal defect (MVSD) to the anterior surface of the aortic root. Contrast-enhanced CT and three-dimensional CT revealed a giant aneurysm located below the aortic root and connected to the left ventricular outflow tract (LVOT). The diagnosis was confirmed by surgery and postoperative pathological examination.
Subject(s)
Echocardiography, Transesophageal , Heart Aneurysm , Heart Septal Defects, Ventricular , Ventricular Septum , Humans , Female , Heart Aneurysm/diagnostic imaging , Heart Aneurysm/surgery , Young Adult , Echocardiography, Transesophageal/methods , Ventricular Septum/diagnostic imaging , Ventricular Septum/surgery , Ventricular Septum/pathology , Heart Septal Defects, Ventricular/surgery , Heart Septal Defects, Ventricular/diagnostic imaging , Tomography, X-Ray Computed , EchocardiographyABSTRACT
A 59-year-old man was admitted to our hospital with left hemiplegia. A computed tomography( CT) scan and echocardiography revealed a cerebral infarction in the right middle cerebral artery's territory, as well as a large pseudoaneurysm (4×3 cm) of the lateral left ventricular wall. The patient agreed to undergo cardiac surgery because of the high risk of rupture and recurrent cerebral infarctions. Owing to the high probability of damaging the posterior papillary muscle and coronary arteries, an extracardiac approach was used, and the pseudoaneurysm cavity was closed using double-patch repair. The patient was discharged from the hospital on the 12th postoperative day without any complications. Both postoperative CT and echocardiography showed closure of the cavity.
Subject(s)
Aneurysm, False , Cerebral Infarction , Heart Ventricles , Humans , Male , Aneurysm, False/diagnostic imaging , Aneurysm, False/surgery , Aneurysm, False/etiology , Middle Aged , Cerebral Infarction/etiology , Cerebral Infarction/diagnostic imaging , Heart Ventricles/diagnostic imaging , Tomography, X-Ray Computed , Heart Aneurysm/diagnostic imaging , Heart Aneurysm/surgery , Heart Aneurysm/etiologyABSTRACT
ABSTRACT: A sub-mitral left ventricular aneurysm is a rare condition. It is a congenital outpouching of the left ventricular wall, invariably occurring adjacent to the posterior mitral leaflet. Sub-mitral aneurysm (SMA) has usually been reported as a consequence of myocardial ischemia (MI), rheumatic heart disease, tuberculosis, and infective endocarditis. Nevertheless, there have been few case reports of congenital SMA in India. It usually presents with symptoms of heart failure. We report a rare case of congenital SMA in a 27-year-old young Indian and its successful management through a trans-aneurysmal approach.
Subject(s)
Heart Aneurysm , Mitral Valve , Humans , Adult , Heart Aneurysm/surgery , Heart Aneurysm/diagnostic imaging , Heart Aneurysm/congenital , Mitral Valve/surgery , Mitral Valve/diagnostic imaging , Male , Heart Ventricles/surgery , Heart Ventricles/diagnostic imaging , Echocardiography, Transesophageal/methods , AnestheticsABSTRACT
Among the cardiac outpouchings, left ventricular aneurysms or pseudo-aneurysms that develop secondary to myocardial infarctions are the most common. On the other hand, atrial appendageal and valvular aneurysms are uncommon occurrences. The appendageal aneurysms develop possibly due to congenital dysplasia of atrial pectinate muscles, while valvular aneurysms result from infective endocarditis, mechanical injury or degenerative changes. Despite their unusual locations, they are prone to life-threatening complications. We present our experience of unusual cardiac aneurysms in surgical cardiovascular material.
Subject(s)
Heart Aneurysm , Humans , Heart Aneurysm/surgery , Heart Aneurysm/pathology , Heart Aneurysm/congenital , Heart Aneurysm/diagnostic imaging , Male , Female , Middle Aged , Aged , Atrial Appendage/pathology , Atrial Appendage/surgery , Adult , Cardiac Surgical ProceduresABSTRACT
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.
Subject(s)
Heart Aneurysm , Heart Rupture, Post-Infarction , ST Elevation Myocardial Infarction , Ventricular Septal Rupture , Aged , Humans , Electrocardiography , Heart Aneurysm/diagnostic imaging , Heart Aneurysm/etiology , Heart Aneurysm/complications , Heart Aneurysm/physiopathology , Heart Rupture, Post-Infarction/etiology , Heart Rupture, Post-Infarction/diagnostic imaging , Heart Rupture, Post-Infarction/diagnosis , Point-of-Care Testing , Predictive Value of Tests , ST Elevation Myocardial Infarction/etiology , ST Elevation Myocardial Infarction/diagnosis , ST Elevation Myocardial Infarction/complications , ST Elevation Myocardial Infarction/therapy , ST Elevation Myocardial Infarction/physiopathology , ST Elevation Myocardial Infarction/diagnostic imaging , Treatment Outcome , Ventricular Septal Rupture/etiology , Ventricular Septal Rupture/diagnostic imaging , Ventricular Septal Rupture/physiopathology , Ventricular Septal Rupture/diagnosis , Ventricular Septal Rupture/surgery , FemaleSubject(s)
Aneurysm, False , Heart Aneurysm , Hematoma , Humans , Aneurysm, False/diagnostic imaging , Aneurysm, False/surgery , Hematoma/diagnostic imaging , Hematoma/surgery , Heart Aneurysm/diagnostic imaging , Heart Aneurysm/surgery , Male , Heart Ventricles/diagnostic imaging , Treatment Outcome , Echocardiography , Middle Aged , Aortic Dissection/diagnostic imaging , Aortic Dissection/surgery , Aortic Dissection/complicationsABSTRACT
A 66-year-old man. He had myocardial infarction due to occlusion of the left anterior descending branch, which was subsequently complicated by ventricular septal perforation. Ventricular septal perforation was repaired through right ventricle incision, applying double patches for closure, and injecting glue between the patches. The early postoperative course was good, but the infarcted left ventricular anterior wall remained because of the right ventriculotomy approach. A left ventricular aneurysm was demonstrated on postoperative follow-up echocardiography, which gradually enlarged to become giant. Since symptoms of heart failure such as respiratory distress appeared, left ventriculoplasty was performed 29 months after the perforation of the initial surgery. Since thinned left ventricular wall remains following right ventriculotomy approach, risk of postoperative left ventricular aneurysm should be taken into account.