[Subcutaneous pseudoaneurysm of the left ventricle--a rare complication of ischemic dilated cardiomyopathy].

INTRODUCTION

Pseudoaneurysm of the heart is extremely rare in cardiology and cardiac surgery. It can be presented as a complication of myocardial infarction, cardiac trauma or surgical intervention.

CASE PRESENTATION

9 years after by-pass surgery combined with left ventricle aneurysmectomy a 69-year-old patient was admitted in hospital after full cardiologic examination. On admission, during routine chest examination 9 years after by-pass surgery combined with left ventricle aneurysmectomy, a great pulsatile mass was found in the region of left mammilla++. A left ventricle aneurysm (aneurysm per magna) was confirmed by all noninvasive and invasive tests, and new surgical aneurysmectomy was indicated. The existence of pseudoaneurysm was suspected by intraoperative transesophageal echocardiography and during the operation a false aneurysm was finally confirmed.

DISCUSSION

False aneurysm develops after acute rupture of an infarcted left ventricle area. It is usually fatal, but if the adhesion or pericardial fibrosis exists and is adherent to epicardium it can create a saccular cavity (hemopericardium). Persistent communication between the left ventricle and hemopericardium can create false aneurysm of different size and shape. In more than 50% of patients false aneurysm is found accidentally. In most cases the pseudoaneurysm is asymptomatic and the treatment is surgical.

CONCLUSION

False aneurysms as case presentations are very rare. Sometimes they are difficult to confirm prior to surgery; even if full diagnostic screening was arranged (including 2-D transthoracic echocardiography, transesophageal echocardiography and complete hemodynamic investigation).