Left ventricular free-wall rupture, a potentially lethal mechanical complication of acute myocardial infarction: an unusual and illustrative case report.

BACKGROUND: There are three major mechanical complications after acute myocardial infarction: left ventricular free-wall rupture, ventricular septum rupture and acute mitral valve regurgitation. The left ventricular free-wall rupture is a serious and often lethal complication following an ST elevation myocardial infarction. However, very rarely this rupture can be contained by the pericardium, forming a pseudoaneurysm. CASE PRESENTATION: We report a case of a 66-year-old man with multiple cardiovascular risk factors and previous ST elevation myocardial infarction, complaining of atypical chest pain. His electrocardiogram was in normal sinus rhythm, with the presence of Q wave in inferior leads and T-wave inversion in lateral leads. A transthoracic echocardiogram showed a left ventricular pseudoaneurysm. In the coronary angiography, multi-vessel disease was found. On-pump CABG was performed and a posterolateral left ventricular giant pseudoaneurysm were observed. Due its "petrous" consistency it was impossible to perform an aneurysmectomy. CONCLUSIONS: The diagnosis of left ventricular pseudoaneurysm can be difficult, as patients often present either asymptomatic or with non-specific symptoms attributed to other causes. A multimodality imaging diagnostic approach can be necessary. Immediate surgery is considered the treatment of choice because untreated pseudoaneurysms have a high risk of rupture leading to cardiac tamponade, shock and death.

Corrección quirúrgica exitosa de ruptura de aneurisma del seno de Valsalva Sakakibara tipo IV y cierre de comunicación interventricular perimembranosa / Successful surgical correction of a rupture of a Sakakibara type IV Valsalva sinus aneurysm and closure of the perimembranous ventricular septal defect

Resumen El aneurisma del seno de Valsalva es una anomalía cardíaca que puede ser congénita o adquirida. Es referido como una anomalía congénita rara, usualmente asintomática detectada en un ecocardiograma 2 D de rutina, hasta presentaciones relacionadas con la compresión de estructuras adyacentes o como cortocircuitos intracardíacos causados por la ruptura de un aneurisma del seno de Valsalva dentro de una cavidad derecha del corazón. Se expone el caso de un paciente de sexo masculino, de 27 años de edad, que acudió al departamento de emergencia con disnea progresiva hasta ser de pequeños esfuerzos a quien se le documentó ruptura de aneurisma del seno de Valsalva no coronariano, clasificación de Sakakibara tipo IV, asociado a comunicación interventricular perimembranosa. Se hizo cirugía cardíaca para tratamiento quirúrgico definitivo, el cual fue exitoso. Se hace una revisión breve de la literatura acerca de esta patología, su definición, etiología, epidemiología, clasificación, diagnóstico y tratamiento.

Abstract An aneurysm of the sinus of Valsalva is a cardiac anomaly that can be congenital or acquired. It is referred to as a rare congenital anomaly, usually asymptomatic and detected in a routine 2-D echocardiogram. It is also found associated with the compression of adjacent structures or as intra-cardiac short-circuits caused by the rupture of an aneurysm of the sinus of Valsalva within a right cavity of the heart. The case is presented of a 27 year-old male, who arrived in the Emergency Department with progressive dyspnoea even with small exertions and was diagnosed with rupture of a Sakakibara type IV, non-coronary sinus of Valsalva aneurysm, associated with a perimembranous ventricular septal defect. Open heart surgery was performed for definitive surgical treatment, which was successful. A short review of the literature is presented on this condition, its definition, aetiology, epidemiology, classification, diagnosis, and treatment.