Chest
ReviewsDistinguishing Left Ventricular Aneurysm From Pseudoaneurysm: A Review of the Literature
Section snippets
DEMONSTRATIVE CASE
A 69-year-old patient with a history of coronary artery disease presented with symptoms of progressive chest pain. He had presented 10 years prior with angina and had undergone coronary artery bypass grafting with a left internal mammary artery to the left anterior descending coronary artery. ECG revealed high lateral ST elevation with small lateral Q waves. He underwent a coronary angiographic examination that revealed a patent left internal mammary artery graft to the left anterior descending
Natural History of Patients With a Pseudoaneurysm
In 1967, Roberts and Morrow4 reported the case of a patient with and reviewed the literature on postinfarction ventricular pseudoaneurysm. They noted six prior reports, the earliest by Corvisart in 1797.5, 6, 7, 8, 9, 10 The patient described by Roberts and Morrow had a large aneurysmal cavity that produced both New York Heart Association class IV heart failure and embolic events, resulting in a decision to resect. A pseudoaneurysm was found at the time of surgery which was repaired, although
Contrast Ventriculography
The first report (to our knowledge) of the successful surgical repair of pseudoaneurysms was published in 1957 by Smith et al.24 In their patients, the diagnosis was made by a technique called direct cardioangiography, which required a needle to be placed in the left atrium percutaneously so that contrast could be injected manually. To our knowledge, there has been no prospective trial of the use of modern ventriculography in distinguishing aneurysms from pseudoaneurysms. There have been two
CONCLUSIONS
At present and to our knowledge, there is no definitive noninvasive test to make the distinction between the two entities on gross inspection. However, the pathologic feature that distinguishes between the two is that a true aneurysm contains elements of myocardium, while a pseudoaneurysm does not. While the differentiation of myocardium vs thrombus lining a pseudoaneurysm cavity may be very difficult to discern with conventional imaging techniques, future advances in tissue characterization
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