Ventricular apical wall rupture and ventricular aneurysm formation concurrent with ventricular septal dissection and rupture due to ST-segment elevation myocardial infarction: a case report.

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.

Giant right atrium, what does it hide? Case presentation.

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.

Impact of revascularization in patients with post-infarction left ventricular aneurysm and ventricular tachyarrhythmia.

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.

Minimally invasive left ventricular reconstruction of a postinfarction, anterior left ventricular scar (BioVentrix Revivent TC procedure).

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.

Does On-Pump Beating Heart Endoaneurysmorrhaphy Have Advantages over Linear Aneurysmectomy on Arrested Heart in the Short Term?

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.

Precision Diagnosis and Treatment of a Giant Pseudoaneurysm of the Right Ventricular Outflow Tract.

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.

Intraventricular muscle bundle as a novel cause of left ventricular aneurysm.

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.

Prevalence and factors associated with spontaneous closure of congenital ventricular septal defects.

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.

Dynamic Systolic Compression of the Left Anterior Descending Coronary Artery as the First Clue of Postinfarction Left Ventricular Pseudoaneurysm.

Left ventricular pseudoaneurysm and left ventricular free wall rupture are rare but life-threatening complications of acute myocardial infarction. Dynamic systolic compression of the coronary arteries is almost always due to myocardial bridging. However, it has rarely been described in patients with ventricular aneurysms and pseudoaneurysms. We present a case of a patient with recent myocardial infarction who presented with recurrence of chest pain and coronary angiogram showing patent vessels however with systolic compression of the distal left anterior descending coronary artery as a first clue to postinfarct left ventricular pseudoaneurysm.

Mid-ventricular obstructive hypertrophic cardiomyopathy with apical aneurysm: An important subtype of arrhythmogenic cardiomyopathy.

Mid-ventricular obstructive hypertrophic cardiomyopathy (MVOHCM) is an uncommon type of HCM. LV apical aneurysms are present in more than 20% MVOHCM cases and has been identified as an independent predictor of potentially lethal arrhythmic events, including non-sustained or sustained ventricular tachycardia (VT), and ventricular fibrillation (VF), as well as SCD. Although the pathogenesis of LVA remains unknown, but it has been suggested that apical aneurysm may be secondary to the increased after-load and high apical pressure arising from significant pressure gradient of the midventricular obstruction. The scarred rim of the aneurysm and the adjacent areas of LV myocardial fibrosis and consequent apical oxygen-demand mismatch may be responsible for the formation of apical aneurysm. Recent electrophysiologic studies have demonstrated that the aneurysmal rim forms the primary culprit arrhythmogenic substrate for generation of monomorphic ventricular tachycardia leading to SCD, but the clinical significance of the size of aneurysm in relation to SCD remains unsettled. We summarized the clinical features of the patients with MVOHCM and apical aneurysms. Appropriate therapeutic interventions include ICD implantation, and early surgical intervention for gradient relief may be undertaken to relief the MVO.

Application of PICCO During Anesthesia of Patients Undergoing Transcatheter Ventricular Isolation Plasty Due to Left Ventricular Aneurysm.

INTRODUCTION: Left ventricular aneurysm is a common complication type of myocardial infarction. Percutaneous ventricular restoration (PVR) is a new and minimally invasive surgical method for left ventricular aneurysm. Due to its complication and high demand on the surgeon, careful cooperation of anesthesia work is of great significance for the successful implementation of the operation. CASE PRESENTATION: During anesthesia, Pulse Index Continuous Cardiac Output (PICCO) not only monitors general hemodynamic parameters, but also displays parameters such as cardiac output, myocardial contractility, pre-cardiac load, etc., which provides important guidance for the anesthetic procedures. CONCLUSIONS: This study aimed to explore the application of PICCO in the anesthesia of patients by analyzing the clinical anesthesia management of 3 cases of patients undergoing transcatheter ventricular partitioning restoration (TVPR) due to left ventricular aneurysm in the case of analysis.