Discussion:
The left ventricular free wall rupture (LVFWR) after MI decreased
drastically in the current era due to the advancement of effective early
revascularization strategies. Sudden cardiac death is a common sequel of
LVFWR, however, in some cases, it can be contained by the superimposing
adherent pericardium resulting in the formation of the pseudoaneurysm.
The pseudoaneurysm communicates with the LV cavity by a narrow neck,
whose diameter is less than 50% of the maximum internal dimensions of
an aneurysm.1 Whereas, LV true aneurysm develops due
to scar thinning of the myocardial wall after MI. It contains all the
three layers of LV i.e endocardium, myocardium, and epicardium, and has
a wide neck, smooth margins. The posterolateral wall is the most common
location for LV pseudoaneurysm , whereas, a true aneurysm, located
commonly in the apicoanterior wall. TTE is used as an initial diagnostic
modality for the assessment of heart after MI. It not only helps in
diagnosis, but also helps in determining the location and extent of the
lesion. Due to its high tendency to expand and rupture, early surgical
intervention is recommended in LV pseudoaneurysm. Our case had developed
a giant LV psudoaneurysm four weeks after the development of MI which
was successfully managed by the surgical intervention.
Reference :
Eren E, Bozbuga N, Toker ME, et al. Surgical treatment of
post-infarction left ventricular pseudoaneurysm: a two-decade
experience. Tex Heart Inst J 2007;34:47–51.
Legends :
Figure 1 - Apical four chamber view showing an apical pseudoaneurysm
(red arrow) with narrow neck (green arrow). RA,Right atrium; RV, Right
ventricle; LA, Left ventricle; LV, Left ventricle.
Figure 2 - Colour Doppler in apical four chamber view showing a free
blood flow between left ventricular cavity and pseudoaneurysm (red
arrow). RA,Right atrium; RV, Right ventricle; LA, Left ventricle; LV,
Left ventricle.
Figure 3 – Surgical image showing a ruptured left ventricular apex
(green arrow).
Video 1 : Apical four chamber view showing an apical pseudoaneurysm with
narrow neck.
Video 2 : Colour Doppler in apical four chamber view showing a free
blood flow between left ventricular cavity and pseudoaneurysm.