Mijatov M, Jonjev Z, Konstantinović Z, Golubović M, Radovanović N
Univerzitetska klinika za kardiovaskularnu hirurgiju, Sremska Kamenica, Medicinski fakultet, Novi Sad.
Med Pregl. 2000 May-Jun;53(5-6):301-4.
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.
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.
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.
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).
心脏假性动脉瘤在心脏病学和心脏外科中极为罕见。它可作为心肌梗死、心脏创伤或手术干预的并发症出现。
一名69岁患者在接受冠状动脉搭桥术联合左心室室壁瘤切除术9年后，经过全面的心脏检查后入院。入院时，在冠状动脉搭桥术联合左心室室壁瘤切除术9年后的常规胸部检查中，发现左乳头区域有一个巨大的搏动性肿块++。所有非侵入性和侵入性检查均证实为左心室室壁瘤（巨大室壁瘤），并建议进行新的手术切除室壁瘤。术中经食管超声心动图怀疑存在假性动脉瘤，手术中最终证实为假性动脉瘤。
假性动脉瘤在梗死的左心室区域急性破裂后形成。它通常是致命的，但如果存在粘连或心包纤维化并附着于心外膜，可形成一个囊腔（心包积血）。左心室与心包积血之间的持续连通可形成大小和形状各异的假性动脉瘤。超过50%的患者假性动脉瘤是偶然发现的。大多数情况下，假性动脉瘤无症状，治疗方法为手术治疗。
作为病例报告的假性动脉瘤非常罕见。有时在手术前很难确诊，即使安排了全面的诊断筛查（包括二维经胸超声心动图、经食管超声心动图和完整的血流动力学检查）。
