RESUMO
BACKGROUND: Percutaneous closure of aortic and ventricular pseudoaneurysms (PSA) has only been reported on a case report and series basis. In previous case reports, percutaneous closure has been performed successfully in patients of prohibitive surgical risk. This case series aims to show feasibility of percutaneous closure of aortic and ventricular pseudoaneurysm secondary to perivalvular leak (PVL) in a small patient population and the utility of multimodality imaging as an integral tool in procedural planning. This is the largest complex case series to date describing the feasibility and success rate of complex PSA closure, with a follow-up period of up to 4 years. MATERIAL AND METHODS: We performed institutional review and systemic literature review to identify all paravalvular leak cases with associated pseudoaneurysm formation for which a closure procedure was performed. Ten patients were identified. Pooled analysis for cases from institutional review (n = 10) and systemic literature review (n = 39) was performed. The success rate was 100 %. At 30-days, the mortality was 0 %. CONCLUSION: In paravalvular leak patients with subsequent pseudoaneurysm formation, exhaustive imaging evaluation is required for closure. However, it can be achievable with favorable rates of success.
Assuntos
Falso Aneurisma , Implante de Prótese de Valva Cardíaca , Humanos , Falso Aneurisma/diagnóstico por imagem , Falso Aneurisma/etiologia , Falso Aneurisma/terapia , Masculino , Feminino , Resultado do Tratamento , Idoso , Pessoa de Meia-Idade , Implante de Prótese de Valva Cardíaca/efeitos adversos , Implante de Prótese de Valva Cardíaca/instrumentação , Aneurisma Cardíaco/diagnóstico por imagem , Aneurisma Cardíaco/etiologia , Aneurisma Cardíaco/terapia , Cateterismo Cardíaco/efeitos adversos , Aneurisma Aórtico/diagnóstico por imagem , Aneurisma Aórtico/cirurgia , Fatores de Tempo , Idoso de 80 Anos ou mais , Próteses Valvulares Cardíacas , Valva Aórtica/cirurgia , Valva Aórtica/diagnóstico por imagem , Ecocardiografia Transesofagiana , AdultoAssuntos
Falso Aneurisma , Aneurisma Cardíaco , Humanos , Falso Aneurisma/diagnóstico por imagem , Falso Aneurisma/cirurgia , Aneurisma Cardíaco/diagnóstico por imagem , Aneurisma Cardíaco/terapia , Resultado do Tratamento , Ventrículos do Coração/diagnóstico por imagem , Ventrículos do Coração/cirurgia , Cateterismo CardíacoRESUMO
BACKGROUND: Left ventricular (LV) apical aneurysms in hypertrophic cardiomyopathy (HCM) are a recognized risk marker for adverse cardiovascular events. There is variable practice among clinicians and discordance between international guidelines regarding treatment recommendations and prognostication for this important phenotype. OBJECTIVES: The authors sought to describe the morphology, clinical course, and risk of adverse events in a large single-center cohort of HCM patients with LV apical aneurysms. METHODS: This study analyzed 160 HCM patients with an LV apical aneurysm who were evaluated in our dedicated HCM clinic between January 1997 and April 2021. RESULTS: Mean age was 59.1 ± 13.6 years, and 71% of these patients were male. Mean aneurysm size was 1.77 ± 1.04 cm. Over 6.2 ± 4.8 years, 14 (9%) patients had a sudden cardiac death (SCD) event, including appropriate therapy from an implantable cardioverter-defibrillator (ICD) or resuscitation from cardiac arrest (annualized event rate 1.77%/y), 39 (24%) had either a thromboembolic stroke or apical thrombus formation (2.9%/y), and 14 (9%) developed LV systolic dysfunction with an ejection fraction (EF) <50% (1.28%/y). HRs for SCD, stroke or thrombus, and EF <50% per 1-cm increase in aneurysm size were 1.69 (P = 0.007), 1.60 (P = 0.0002), and 1.63 (P = 0.01), respectively. Aneurysm size ≥2 cm was associated with a 5-year SCD rate of 9.7%, compared with 2.9% for aneurysm size <2 cm (log-rank P = 0.037). This subgroup also had higher risk of stroke/thrombus formation (HR: 2.20; P = 0.002), with an annualized event rate of 2.7%/year. A total of 39 (24%) patients reached the combined end point of SCD, stroke, or LV dysfunction (2.12%/y) with an HR of 1.47/cm increase in aneurysm size (P = 0.003) and an HR of 2.22 for patients with aneurysm size ≥2 cm (P = 0.02). CONCLUSIONS: Increasing aneurysm size confers poorer prognosis. Aneurysm size ≥2 cm should alert potential consideration for prophylactic anticoagulation and primary prevention ICDs.
Assuntos
Cardiomiopatia Hipertrófica , Aneurisma Cardíaco , Acidente Vascular Cerebral , Anticoagulantes , Cardiomiopatia Hipertrófica/complicações , Cardiomiopatia Hipertrófica/diagnóstico por imagem , Cardiomiopatia Hipertrófica/terapia , Morte Súbita Cardíaca/etiologia , Feminino , Aneurisma Cardíaco/complicações , Aneurisma Cardíaco/diagnóstico por imagem , Aneurisma Cardíaco/terapia , Humanos , Masculino , Valor Preditivo dos Testes , Prognóstico , Fatores de Risco , Acidente Vascular Cerebral/complicaçõesAssuntos
Falso Aneurisma , Aneurisma Cardíaco , Falso Aneurisma/diagnóstico por imagem , Falso Aneurisma/etiologia , Falso Aneurisma/terapia , Angioplastia , Aneurisma Cardíaco/diagnóstico por imagem , Aneurisma Cardíaco/etiologia , Aneurisma Cardíaco/terapia , Ventrículos do Coração/diagnóstico por imagem , HumanosRESUMO
AIM: To report on the feasibility, efficacy and long-term outcome of transcatheter closure of fenestrated Atrial Septal Aneurysm (ASA). METHODS: Between April 2000 and May 2020, 568 patients with fenestrated ASA underwent transcatheter closure at two large-volume Pediatric Cardiology and GUCH Units (Naples and Massa, Italy). Procedural indications were cardiac volume overload in 223 patients (39%) or prophylaxis of paradoxical embolization in 345 patients (61%). Patients' median age and weight were 42âyears (rangeâ19-52) and 66âkg (range 54-79), respectively. One-hundred and thirty-nine patients (25%) were younger than 18 years. RESULTS: Single fenestration was found in 311 patients (55%) (Group 1), whereas 257 patients (45%) had multifenestrated ASA (Group 2). The procedure was successful in all but seven patients (1.2%). In Group 1, closure was achieved with a single device. In Group 2, one device was used in 168 patients (67%), two devices in 74 patients (28%), three devices in 12 patients (5%), and four devices in 1 patient (0.3%). The early complication rate was 3%, without any difference according to anatomy or patient's age. At discharge, complete shunt closure was higher in Group 1 (92% vs. 72%, Pâ<â0.0001), without any difference between groups at the last follow-up evaluation (100% vs. 99%, Pâ=â0.12). Procedural safety was persistent during the long-term follow-up (mean 7.2â±â5.4, range 0-19âyears): freedom from adverse events was 97% at 10-15âyears. Seventeen patients (3%) were submitted to reintervention, mostly as prophylaxis of paradoxical embolization. CONCLUSION: Transcatheter closure of perforated ASA is technically feasible in a high percentage of cases, with excellent long-term outcomes.
Assuntos
Aneurisma Cardíaco/terapia , Comunicação Interatrial/terapia , Dispositivo para Oclusão Septal , Adulto , Estudos de Viabilidade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Análise de Sobrevida , Adulto JovemRESUMO
Spontaneous left ventricular pseudoaneurysms are very rare and can have catastrophic consequences if unrecognized. A case of combined spontaneous left ventricular aneurysm and pseudoaneurysm in Behcet's disease (BD) has been reported. The case emphasizes advanced techniques for percutaneous closure of the defects with the use of an ex-vivo three-dimensional cardiac printed model as a tool to facilitate the procedure.
Assuntos
Falso Aneurisma , Síndrome de Behçet , Aneurisma Cardíaco , Falso Aneurisma/diagnóstico por imagem , Falso Aneurisma/etiologia , Falso Aneurisma/terapia , Síndrome de Behçet/complicações , Síndrome de Behçet/diagnóstico , Aneurisma Cardíaco/diagnóstico por imagem , Aneurisma Cardíaco/etiologia , Aneurisma Cardíaco/terapia , Ventrículos do Coração/diagnóstico por imagem , Humanos , Resultado do TratamentoAssuntos
Aneurisma Cardíaco/complicações , Ventrículos do Coração/diagnóstico por imagem , Ventrículos do Coração/fisiopatologia , Miocardite/complicações , Imunodeficiência Combinada Severa/complicações , Cateterismo Cardíaco/métodos , Cardiotônicos/uso terapêutico , Pré-Escolar , Eletrocardiografia/métodos , Células Gigantes , Aneurisma Cardíaco/terapia , Humanos , Imageamento por Ressonância Magnética/métodos , Masculino , Milrinona/uso terapêutico , Miocardite/tratamento farmacológicoRESUMO
BACKGROUND: Left ventricular pseudoaneurysm due to early left ventricle rupture is a serious complication after cardiac surgery. Urgent surgery is recommended in most cases with a high mortality rate. Conservative treatment of a left ventricular pseudoaneurysm due to early left ventricle rupture is very rare. CASE PRESENTATION: We present a 61-year-old woman with left ventricular pseudoaneurysm after mitral valve replacement due to early left ventricle rupture. This patient was treated in a conservative approach. This patient had an uneventful recovery. She was in good condition and remained asymptomatic 3.5 years after mitral valve surgery. CONCLUSION: This case suggests that medical treatment left ventricular pseudoaneurysm patients has a limited but acceptable role in selected and unusual circumstances.
Assuntos
Falso Aneurisma/terapia , Aneurisma Cardíaco/terapia , Ruptura Cardíaca/complicações , Próteses Valvulares Cardíacas/efeitos adversos , Estenose da Valva Mitral/cirurgia , Valva Mitral/cirurgia , Complicações Pós-Operatórias , Falso Aneurisma/diagnóstico , Tratamento Conservador/efeitos adversos , Feminino , Aneurisma Cardíaco/diagnóstico , Ruptura Cardíaca/diagnóstico , Ruptura Cardíaca/terapia , Ventrículos do Coração , Humanos , Pessoa de Meia-IdadeAssuntos
Técnicas de Imagem Cardíaca , Divertículo/diagnóstico por imagem , Aneurisma Cardíaco/diagnóstico por imagem , Cardiopatias Congênitas/diagnóstico por imagem , Ruptura do Septo Ventricular/diagnóstico por imagem , Adulto , Angiografia por Tomografia Computadorizada , Angiografia Coronária , Diagnóstico Diferencial , Divertículo/terapia , Ecocardiografia , Feminino , Aneurisma Cardíaco/terapia , Cardiopatias Congênitas/terapia , Humanos , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Imagem Multimodal , Valor Preditivo dos Testes , Ruptura do Septo Ventricular/terapiaAssuntos
Falso Aneurisma/etiologia , Infarto Miocárdico de Parede Anterior/complicações , Aneurisma Cardíaco/etiologia , Ruptura do Septo Ventricular/etiologia , Idoso , Falso Aneurisma/diagnóstico por imagem , Falso Aneurisma/fisiopatologia , Falso Aneurisma/terapia , Infarto Miocárdico de Parede Anterior/diagnóstico por imagem , Cateterismo Cardíaco/instrumentação , Feminino , Aneurisma Cardíaco/diagnóstico por imagem , Aneurisma Cardíaco/fisiopatologia , Aneurisma Cardíaco/terapia , Humanos , Resultado do Tratamento , Ruptura do Septo Ventricular/diagnóstico por imagem , Ruptura do Septo Ventricular/fisiopatologia , Ruptura do Septo Ventricular/terapiaRESUMO
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.
Assuntos
Circulação Coronária , Aneurisma Cardíaco/etiologia , Cardiopatias Congênitas/complicações , Hemodinâmica , Músculos Papilares/anormalidades , Função Ventricular Esquerda , Adulto , Idoso , Anticoagulantes/uso terapêutico , Procedimentos Cirúrgicos Cardíacos , Feminino , Aneurisma Cardíaco/diagnóstico por imagem , Aneurisma Cardíaco/fisiopatologia , Aneurisma Cardíaco/terapia , Cardiopatias Congênitas/diagnóstico por imagem , Cardiopatias Congênitas/fisiopatologia , Cardiopatias Congênitas/terapia , Humanos , Masculino , Músculos Papilares/diagnóstico por imagem , Músculos Papilares/fisiopatologia , Músculos Papilares/cirurgia , Resultado do TratamentoRESUMO
There are limited data on the prevalence and an outcome of left ventricular (LV) aneurysms following acute myocardial infarction (AMI). Using the National Inpatient Sample during 2000 to 2017, a retrospective cohort of AMI admissions was evaluated for LV aneurysms. Complications included ventricular arrhythmias, mechanical, cardiac arrest, pump failure, LV thrombus, and stroke. Outcomes of interest included in-hospital mortality, temporal trends, complications, hospitalization costs, and length of stay. A total 11,622,528 AMI admissions, with 17,626 (0.2%) having LV aneurysms were included. The LV aneurysm cohort was more often female, with higher comorbidity, and admitted to large urban hospitals (all p < 0.001). In 2017, compared with 2000, there was a slight increase in LV aneurysms prevalence in those with (adjusted odds ratio [aOR] 1.57 [95% confidence interval {CI} 1.41 to 1.76]) and without (aOR 1.13 [95% CI 1.00 to .127]) ST-segment-elevation AMI (p < 0.001 for trend). LV aneurysms were more commonly noted with anterior ST-segment-elevation AMI (31%) compared with inferior (12.3%) and other (7.9%). Ventricular arrhythmias (17.6% vs 8.0%), mechanical complications (2.6% vs 0.2%), cardiac arrest (7.1% vs 5.0%), pump failure (26.3% vs 16.1%), cardiogenic shock (10.0% vs 4.8%) were more common in the LV aneurysm cohort (all p < 0.001). Those with LV aneurysms had comparable in-hospital mortality compared with those without (7.4% vs 6.2%; aOR 1.02 [95% CI 0.90 to 1.14]; pâ¯=â¯0.43). The LV aneurysm cohort had longer length of hospital stay, higher hospitalization costs, and fewer discharges to home. In conclusion, LV aneurysms were associated with higher morbidity, more frequent complications, and greater in-hospital resource utilization, without any differences in in-hospital mortality in AMI.
Assuntos
Aneurisma Cardíaco/epidemiologia , Infarto do Miocárdio/complicações , Idoso , Idoso de 80 Anos ou mais , Feminino , Aneurisma Cardíaco/diagnóstico , Aneurisma Cardíaco/terapia , Ventrículos do Coração , Mortalidade Hospitalar , Hospitalização , Humanos , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/mortalidade , Infarto do Miocárdio/terapia , Razão de Chances , Prevalência , Estudos Retrospectivos , Fatores de Risco , Taxa de Sobrevida , Fatores de TempoAssuntos
Falso Aneurisma/etiologia , Estenose da Valva Aórtica/cirurgia , Aneurisma Cardíaco/etiologia , Traumatismos Cardíacos/etiologia , Substituição da Valva Aórtica Transcateter/efeitos adversos , Idoso , Falso Aneurisma/diagnóstico por imagem , Falso Aneurisma/terapia , Estenose da Valva Aórtica/diagnóstico por imagem , Angiografia por Tomografia Computadorizada , Angiografia Coronária , Ecocardiografia Doppler em Cores , Aneurisma Cardíaco/diagnóstico por imagem , Aneurisma Cardíaco/terapia , Traumatismos Cardíacos/diagnóstico por imagem , Traumatismos Cardíacos/terapia , Humanos , Masculino , Imagem Multimodal , Índice de Gravidade de Doença , Resultado do TratamentoRESUMO
We report interventional treatment of a congenital left ventricular aneurysm in a neonate. The aneurysm was detected prenatally at 20 weeks of gestation. Postnatally, the aneurysm increased in size during the first few days of life and therefore we opted for interventional closure to abolish the potential risk of rupture. The aneurysm was entered with a 2.7 French microcatheter, and complete occlusion was achieved by successive placement of three detachable large volume coils (Ruby Coil PenumbraR , Alameda, California). To the best of our knowledge, this is the first report describing interventional occlusion of a congenital ventricular aneurysm in early infancy. Interventional occlusion with detachable large volume coils appears to be an attractive alternative to surgical resection in patients presenting with ventricular outpouchings and narrow base connection to the ventricle.
Assuntos
Cateterismo Cardíaco/instrumentação , Embolização Terapêutica/instrumentação , Aneurisma Cardíaco/terapia , Ecocardiografia Doppler em Cores , Aneurisma Cardíaco/congênito , Aneurisma Cardíaco/diagnóstico por imagem , Humanos , Recém-Nascido , Resultado do Tratamento , Ultrassonografia Pré-NatalRESUMO
BACKGROUND: Left ventricular pseudoaneurysm is a very rare complication following acute myocardial infarction, which results from a free wall rupture. Hemopericardium and cardiac tamponade caused by rupture of the free wall after acute myocardial infarction are often fatal. It is difficult to fully document the evolution of left ventricular pseudoaneurysm resulted from acute myocardial infarction with conservative treatment. CASE PRESENTATION: Herein, we followed a 75-year-old female patient for 3 years. Recorded the evolution of the disease: acute lateral myocardial infarction - emergency reperfusion therapy - cardiac rupture - positive successful rescue - the pseudoaneurysm formation - maintaining conservative treatment - gradual enlargement of the pseudoaneurysm - thrombosis in pseudoaneurysm - thrombus filling with pseudoaneurysm - finally stabilized condition - the treatment of coronary revascularization. CONCLUSIONS: This case is reported here because of its scarcity, which provides provides us with a complete record of the entire evolution and an astonishing indication of the long-term prognosis of non-surgical treatment for pseudoventricular.
Assuntos
Falso Aneurisma/etiologia , Aneurisma Cardíaco/etiologia , Ruptura Cardíaca Pós-Infarto/etiologia , Infarto do Miocárdio com Supradesnível do Segmento ST/complicações , Idoso , Falso Aneurisma/diagnóstico por imagem , Falso Aneurisma/cirurgia , Angioplastia Coronária com Balão/instrumentação , Fármacos Cardiovasculares/uso terapêutico , Tratamento Conservador , Progressão da Doença , Feminino , Aneurisma Cardíaco/diagnóstico por imagem , Aneurisma Cardíaco/terapia , Ruptura Cardíaca Pós-Infarto/diagnóstico por imagem , Ruptura Cardíaca Pós-Infarto/terapia , Humanos , Infarto do Miocárdio com Supradesnível do Segmento ST/diagnóstico , Infarto do Miocárdio com Supradesnível do Segmento ST/terapia , Stents , Trombectomia , Fatores de Tempo , Resultado do TratamentoAssuntos
Aneurisma Cardíaco/diagnóstico por imagem , Ruptura Cardíaca Pós-Infarto/diagnóstico por imagem , Infarto do Miocárdio/complicações , Trombose/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Aneurisma Cardíaco/etiologia , Aneurisma Cardíaco/terapia , Ruptura Cardíaca Pós-Infarto/etiologia , Ruptura Cardíaca Pós-Infarto/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/diagnóstico por imagem , Valor Preditivo dos Testes , Trombose/etiologia , Trombose/terapiaRESUMO
We present a case of a 90â¯year-old-patient who presented with syncope. She had previous inferior acute myocardial infarction 10â¯years ago. Coronary angiography revealed left ventricular pseudoaneurysm, which was confirmed on cardiac computed tomography. The patient refused surgical repair and implantable cardioverter defibrillator insertion and was discharged from the hospital alive. This case demonstrates the possibility of long-term survival with left ventricular pseudoaneurysm and the increasing detection of 'incidental' left ventricular pseudoaneurysm with more frequent use of imaging.
Assuntos
Falso Aneurisma/etiologia , Aneurisma Cardíaco/etiologia , Infarto Miocárdico de Parede Inferior/complicações , Idoso de 80 Anos ou mais , Falso Aneurisma/diagnóstico por imagem , Falso Aneurisma/terapia , Feminino , Aneurisma Cardíaco/diagnóstico por imagem , Aneurisma Cardíaco/terapia , Humanos , Infarto Miocárdico de Parede Inferior/diagnóstico por imagem , Fatores de TempoRESUMO
Hypertrophic cardiomyopathy with left ventricular (LV) mid-cavity obstruction and LV apical aneurysm is associated with high morbidity and mortality rates. However, consensus is lacking on the treatment modality for LV mid-cavity obstruction and LV apical aneurysm. Here, we report a case of reduced LV mid-cavity pressure gradient and symptoms, treated using permanent pacing. The effect of permanent pacing on pressure gradient and symptoms lasted for 4 years. As pacing is relatively non-invasive compared to surgical therapy, permanent pacing is a good option, especially in the elderly patients with LV mid-cavity obstruction and apical aneurysm.
Assuntos
Estimulação Cardíaca Artificial , Cardiomiopatia Hipertrófica/complicações , Cardiomiopatia Hipertrófica/terapia , Aneurisma Cardíaco/complicações , Disfunção Ventricular Esquerda/complicações , Obstrução do Fluxo Ventricular Externo/complicações , Idoso , Cardiomiopatia Hipertrófica/diagnóstico , Feminino , Aneurisma Cardíaco/diagnóstico , Aneurisma Cardíaco/terapia , Humanos , Marca-Passo Artificial , Disfunção Ventricular Esquerda/diagnóstico , Disfunção Ventricular Esquerda/terapia , Obstrução do Fluxo Ventricular Externo/diagnóstico , Obstrução do Fluxo Ventricular Externo/terapiaRESUMO
Left ventricle pseudoaneurysm is a rare complication of myocardial infarction that carries a high risk of mortality. In this report, we present a case of successful percutaneous closure of left ventricle pseudoaneurysm using 3D printing for procedure guidance.