© Borgis - New Medicine 4/2006, s. 122-123
*Zbigniew Juraszyński1, Jerzy Pręgowski2, Zofia T. Bilińska2, Marcin Demkow2, Dorota Piotrowska-Kownacka3, Witold Rużyłło2
False diagnosis of false left ventricular aneurysm in patient with post-infarction VSD
1First Department of Cardiac Surgery, Institute of Cardiology, Warsaw
Head of department: Prof. Witold Rużyłło
2First Department of Coronary Artery Disease, Institute of Cardiology, Warsaw
Head of department: Prof. Andrzej Biederman
3Nuclear Medicine Department, Warsaw Medical Academy, Warsaw
Head of department: Prof. Grzegorz Opolski
A case of 57-year-old man with acute inferior myocardial infarction treated with primary angioplasty of the right coronary artery is reported. The patient was referred for urgent cardiac surgery. After finishing the procedure the patient was discharged from hospital in a good clinical condition.
Rupture of the free wall of the left ventricle is a serious complication of acute myocardial infarction, in most cases leading to death. However, this complication, if not lethal, may sometimes lead to the formation of a left ventricle pseudoaneurysm. There have been several case reports describing patients with this clinical condition [1-3]. The optimal treatment of these patients remains unknown1. The current manuscript will describe the case of a patient with misdiagnosed left ventricle pseudoaneurysm.
A 57-year-old man with acute inferior myocardial infarction was treated with primary angioplasty of the right coronary artery. However, no adequate perfusion was restored due to the no-reflow phenomenon, which occurs in up to 30% of primary PTCA and may contribute to rupture of the left ventricle free wall [4-8]. Five days after the procedure the patient developed a new heart murmur. On echocardiography ventricular septal defect (VSD) and pericardial fluid were found. The thickness of the fluid layer was 25 mm with fibrin deposits. Left ventricle postero-inferior wall and interventricle septum were thinned, dyskinetic with aneurysm formation. Overall, echocardiography suggested left ventricle pseudoaneurysm. Cardiac Magnetic Resonance Imaging (MRI) was performed; VSD was confirmed and pseudoaneurysm formation of the inferior wall of the left ventricle was suspected. Pericardial fluid thickness assessed with MRI was 16 mm with clearly visible fibrin deposits. After contrast medium injection, signal enhancement from the pericardial fluid was detected, further supporting evidence for communication between the left ventricle and the pericardial space. The patient was referred for urgent cardiac surgery.
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Adres do korespondencji:
First Department of Cardiac Surgery
Institute of Cardiology, Warsaw
Alpejska Str. 42, 64-628 Warsaw
tel. (4822) 343-42-11, e-mail: firstname.lastname@example.orgNew Medicine 4/2006
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