Peritoneal pericardial diaphragmatic hernia with an incidental finding of suspected right ventricular wall aneurysms in a dog.

A 3-year-old neutered male standard poodle mix dog was presented because of acute onset vomiting, increased respiratory effort, hyporexia, and progressive lethargy. On physical examination, intermittent tachycardia, tachypnea with mildly increased respiratory effort, and bilateral ventral muffled lung sounds were noted. Thoracic and abdominal computed tomography with contrast revealed a peritoneal pericardial diaphragmatic hernia (PPDH) with herniation of the liver and gallbladder, moderate abdominal lymphadenopathy, and mild pleural effusion. The dog underwent an emergency laparotomy and median sternotomy. Right ventral PPDH with a herniated, necrosed, and nonviable quadrate liver lobe and gallbladder; 2 suspected right ventricular (RV) aneurysms; and generalized mesenteric and portal lymphadenopathy were present. The affected liver lobe and gallbladder were removed; suspected aneurysms were managed by placing 2 purse-string sutures around the lesions and anchoring a pericardial flap over the aneurysms. The dog developed a ventricular arrhythmia postoperatively. Due to the arrhythmia and intraoperative findings of suspected aneurysms, echocardiography was performed and revealed focal RV systolic dysfunction, left ventricular systolic dysfunction, mild left ventricular dilation, and a hyperechoic area on the RV free wall, consistent with the purse string. An angiotensin-convertingenzyme (ACE) inhibitor was prescribed for left ventricular dilation. The dog was discharged 4 d postoperatively and was doing well 12 mo postoperatively. To our knowledge, this is the first report of a PPDH and suspected concurrent RV wall aneurysm in a dog successfully treated with a purse string and pericardial flap. Key clinical message: An RV aneurysm is extremely rare yet can be life-threatening in small animals. Early detection and treatment may minimize the risk of aneurysm rupture and sudden death.

Hernie diaphragmatique péritonéale péricardique avec découverte fortuite d'anévrismes suspects de la paroi ventriculaire droite chez un chienUn chien croisé caniche standard mâle castré âgé de 3 ans a été présenté en raison de vomissements aigus, d'efforts respiratoires accrus, d'hyporexie et de léthargie progressive. À l'examen physique, une tachycardie intermittente, une tachypnée avec effort respiratoire légèrement accru et des bruits pulmonaires étouffés ventraux bilatéraux ont été notés. Une tomodensitométrie thoracique et abdominale avec contraste a révélé une hernie diaphragmatique péritonéale péricardique (HDPP) avec hernie du foie et de la vésicule biliaire, une lymphadénopathie abdominale modérée et un épanchement pleural léger. Le chien a subi une laparotomie d'urgence et une sternotomie médiane. Une HDPP ventrale droite avec un lobe hépatique carré et une vésicule biliaire herniés, nécrosés et non viables; 2 anévrismes du ventricule droit (VD) suspectés; et une adénopathie mésentérique et portale généralisée étaient présents. Le lobe hépatique et la vésicule biliaire affectés ont été retirés; les anévrismes suspectés ont été gérés en plaçant 2 sutures en bourse autour des lésions et en ancrant un lambeau péricardique sur les anévrismes. Le chien a développé une arythmie ventriculaire postopératoire. En raison de l'arythmie et des résultats peropératoires d'anévrismes suspectés, une échocardiographie a été réalisée et a révélé un dysfonctionnement systolique focal du VD, un dysfonctionnement systolique du ventricule gauche, une légère dilatation du ventricule gauche et une zone hyperéchogène sur la paroi libre du VD, compatible avec la bourse. Un inhibiteur de l'enzyme de conversion de l'angiotensine (ECA) a été prescrit pour la dilatation du ventricule gauche. Le chien a obtenu son congé 4 jours après l'opération et se portait bien 12 mois après l'opération. À notre connaissance, il s'agit du premier rapport d'une HDPP et d'un anévrisme concomitant suspecté de la paroi du VD chez un chien traité avec succès par une suture en bourse et un lambeau péricardique.Message clinique clé :Un anévrisme du ventricule droit est extrêmement rare, mais peut mettre la vie en danger chez les petits animaux. Une détection et un traitement précoces peuvent minimiser le risque de rupture d'anévrisme et de mort subite.(Traduit par Dr Serge Messier).

Surgical Repair of Postinfarction Left Ventricular Pseudoaneurysm.

Left ventricular pseudoaneurysm is a serious and rare disorder that usually develops after acute myocardial infarction. It can lead to potentially lethal mechanical complications, such as acute left ventricular free wall rupture. This report presents the case of a 64-year-old man with a left ventricular pseudoaneurysm and myocardial rupture that was managed by left ventricular restoration with aneurysmectomy and coronary artery bypass with 2 grafts.

Clinical characteristics and prognostic importance of anticoagulant use in ischemic left ventricular aneurysm: a retrospective cohort study.

There is insufficient data on systemic embolic events (SSEs) in patients with ischemic left ventricular aneurysm (LVA) concerning the impact of anticoagulation therapy. In this retrospective cohort study with 1043 patients with ischemic LVA, SSEs occurred in 7.2% over 2.4 years. After adjusting for relevant factors, the use of anticoagulants was independently associated with a lower incidence of SSE (3.1% vs. 9.0%, P < 0.001; subdistribution hazard ratios (SHR) 0.21, 95% confidence intervals (CI) 0.10-0.44, P < 0.001), with no significant difference in net adverse clinical events (NACEs) (10.6% vs. 13.3%, P = 0.225). Specifically, anticoagulation in patients with apical segment akinesis significantly reduced SSEs (3.9% vs. 13.6%, P = 0.002) and NACE rates (7.8% vs. 19.4%, P = 0.002). Major bleeding rates did not significantly differ between groups (5.6% vs. 3.5%, P = 0.111). These findings highlight the SSE risk in ischemic LVA and suggest potential benefits of anticoagulation, particularly in those with apical segment akinesis. These findings need to be validated in independent datasets.

Delayed ventricular septal rupture complicated with ventricular aneurysm in a case of myocardial infarction with non-obstructive coronary arteries.

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.

Atypical left-ventricular hypertrophy with apical aneurysm in leopard syndrome.

Noonan Syndrome with Multiple Lentigines (NSML-formerly known as LEOPARD syndrome) is a rare autosomal dominant condition that usually exhibits cardiac involvement with hypertrophic cardiomyopathy (HCM). Here we present a case of a NSML patient with an unusual and patchy cardiac hypertrophy distribution.

Ventricular restoration in adults with huge congenital left ventricular aneurysm: report of two cases.

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.

Exploratory analysis of predictors of ventricular aneurysm in a cohort of 291 patients with acute myocardial infarction.

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.

Characteristics of Akinetic and Dyskinetic Left Ventricular Aneurysms in the Context of Echocardiographic Diagnosis and Treatment Selection.

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.

[A Giant Pseudoaneurysm Associated with a True Left Ventricular Aneurysm].

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.

Echocardiographic features of a giant aneurysm of membranous ventricular septum.

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.

Multiple aortic root pseudoaneurysms with dissecting aneurysm of the interventricular septum diagnosed by multimodal imaging.

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.

Landscape therapy: rehabilitation potential in patients with post-infarction cardiosclerosis.

OBJECTIVE: Aim: To evaluate the rehabilitation potential, effectiveness and safety of landscape therapy in the complex rehabilitation treatment of patients with post-infarction cardiosclerosis (PC) complicated by chronic post-infarction cardiac aneurysm (CPCA) at the sanatorium stage. PATIENTS AND METHODS: Materials and Methods: We examined 62 patients with PC complicated by CPCA aged 38 to 65 years. Patients were randomized into two groups: the 1st group was undergoing the "Progressive gait" physical activity protocol in the city, and the 2nd group - in the rehabilitation department in a sanatorium. Survey, six-minute walk test, electrocardiography, echocardiography, coronary angiography were performed. RESULTS: Results: The average distance that 2nd group patients walked in 6 minutes increased from 301.00 ±17.00 to 467.00 ±32.00 m (p<0.05). Only in patients of 2nd group during 3 weeks of complex rehabilitation there was a decrease in body mass index from 23.70 ±1.60 to 18.90 ±1.50 and the diameter of the calf muscle significantly increased from 33.90 ±2.30 cm to 38.10 ±3.10 cm (p < 0.05). Ejection fraction in the 2nd group was 51.00 ±4.50% compared to the 1st group - 44.70 ±3.60% (p < 0.05), which was accompanied by a decrease in the functional class of heart failure in patients of the 2nd group. CONCLUSION: Conclusions: The rehabilitation potential of landscape therapy in the complex rehabilitation treatment of patients with complicated PC at the sanatorium stage is determined by a significant improvement in myocardial contractility and physical endurance of patients, and improving the quality of life.

Thirty-three-year follow-up of pseudoaneurysm of the mitral-aortic intervalvular fibrosa without surgical treatment: a case report and literature review.

BACKGROUND: Pseudoaneurysm of the mitral-aortic intervalvular fibrosa (PMAIF) is a rare complication of infective endocarditis or aortic valve surgery. Surgical treatment is suggested, but the long-term follow-up of conservative management remains unclear. CASE PRESENTATION: A 33-year follow-up of a patient who developed PMAIF six years after aortic valve replacement is reported. The patient presented to our center with dyspnea, and the echocardiography revealed an ejection fraction of 20% and a PMAIF measuring 7 × 10 mm. Despite being advised to undergo surgery, the patient declined due to fear of surgical outcomes. Consequently, conservative treatment with close observation but without surgery was initiated. During the 33-year follow-up period, the patient did not experience any adverse health effects. CONCLUSION: Surgical intervention should be considered whenever the PMAIF is diagnosed. However, in any case that the surgery was not applicable, conservative management might lead to long-term survival, based on this and similar case reports in the literature.

A rare case of left atrial appendage aneurysm.

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.

A Surviving Case of Myocardial Infarction with Ventricular Septal Rupture and Ventricular Aneurysm following Gastrointestinal Bleeding.

A 55-year-old man presented to the emergency department with worsening shortness of breath 1 month after a gastrointestinal bleed. He had congestive heart failure, and an electrocardiogram suggested ischemic heart disease involvement. Echocardiography revealed a ventricular septal defect complicated by a left ventricular aneurysm in the inferior-posterior wall. Conservative treatment was started, but hemodynamic collapse occurred on the third day of admission and coronary angiography revealed a revascularizing lesion in the right fourth posterior descending coronary artery. Subsequently, his hemodynamic status continued to deteriorate, even with an Impella CP® heart pump, so ventricular septal defect patch closure and left ventricular aneurysm suture were performed. His condition improved and he was discharged on day 23 of admission and was not readmitted within 6 months after the procedure. Hemodynamic management of ventricular septal defects requires devices that reduce afterload, and clinicians should be aware of the risk of myocardial infarction after gastrointestinal bleeding.