Varvarigos Nikolaos, Koletsis Efstratios, Zafiropoulos Athanasios, Papaioannou Harilaos, Migdalis Ilias
Department of Cardiology, NIMTS Hospital, Athens, Greece.
Med Sci Monit. 2005 Nov;11(11):CS69-73.
Left ventricular pseudoaneurysm is a rare and extremely fatal complication of acute myocardial infarction. It is defined as a rupture of the myocardium contained by epicardial adhesions or the epicardial wall.
A 76-year-old woman was brought to our department suffering from acute pulmonary edema and left ventricular pseudoaneurysm. This condition was caused by an unrecognized high lateral myocardial infarction, which was diagnosed and treated conventionally. Four years after the diagnosis was made, the patient is in good physical condition. The presentation, imaging findings, and the prognosis of such cases are briefly discussed. We have especially focused on the imaging techniques currently used to confirm the diagnosis and on the fact that although the patient refused to have an operation (most appropriate for the diagnosis), she still lives in good physical condition (NYHA II).
We report a case of post infarction pseudoaneurysm along with review of the literature on the subject. We discuss the role of computed tomography and magnetic resonance imaging to ascertain the diagnosis and the algorithm of therapeutic management. Based on current literature, we believe that surgical resection is the treatment of choice for patients in whom a pseudoaneurysm is detected within three months after myocardial infarction, for patients with other indications for cardiac surgery, and for symptomatic patients with ventricular tachycardia or recurrent embolism related to the pseudoaneurysm. Optimum medical therapy is the only alternative in those high-risk patients who refuse surgical operation.
左心室假性动脉瘤是急性心肌梗死一种罕见且极其致命的并发症。它被定义为心肌破裂后被心包粘连或心包壁包裹。
一名76岁女性因急性肺水肿和左心室假性动脉瘤被送至我院。此病症由未被识别的高位侧壁心肌梗死引起，按常规方法进行了诊断和治疗。确诊四年后，患者身体状况良好。简要讨论了此类病例的临床表现、影像学检查结果及预后。我们特别关注了目前用于确诊的影像学技术，以及尽管患者拒绝接受手术（对该诊断最为合适），但她身体状况仍良好（纽约心脏协会心功能分级II级）这一事实。
我们报告了一例心肌梗死后假性动脉瘤病例，并对该主题的文献进行了综述。我们讨论了计算机断层扫描和磁共振成像在确诊中的作用以及治疗管理的策略。基于当前文献，我们认为对于在心肌梗死后三个月内检测到假性动脉瘤的患者、有其他心脏手术指征的患者以及有与假性动脉瘤相关的室性心动过速或反复栓塞症状的患者，手术切除是首选治疗方法。对于那些拒绝手术的高危患者，最佳药物治疗是唯一选择。
