鉴别左心室真性动脉瘤与假性动脉瘤：一例病例报告及文献综述

Zoffoli Giampaolo, Mangino Domenico, Venturini Andrea, Terrini Alberto, Asta Angiolino, Zanchettin Chiara, Polesel Elvio

Department of Cardiac Surgery, Ospedale dell'Angelo, Via Paccagnella 11, 30174, Venice, Mestre, Italy.

J Cardiothorac Surg. 2009 Feb 24;4:11. doi: 10.1186/1749-8090-4-11.

Rupture of the free wall of the left ventricle (LV) is a catastrophic complication occurring in 4% of patients after myocardial infarction (MI) and in 23% of those who die of MI. Rarely the rupture is contained by an adherent pericardium creating a pseudo-aneurysm. This clinical finding calls for emergency surgery. If no ruptures are detectable and myocardium wall integrity is confirmed, we are in the presence of a true aneurysm, which can be treated by means of elective surgery. Differentiation between these two pathologies remains difficult. We report the case of a patient with a true aneurysm, initially diagnosed as pseudo-aneurysm at our institution; we have reviewed the literature on this difficult diagnosis and outlined characteristic findings of each clinical entity.

左心室游离壁破裂是一种灾难性并发症，发生在4%的心肌梗死（MI）患者中，在死于MI的患者中占23%。很少有破裂被粘连的心包包裹形成假性动脉瘤。这一临床发现需要紧急手术。如果未检测到破裂且心肌壁完整性得到确认，则存在真性动脉瘤，可通过择期手术治疗。区分这两种病理情况仍然困难。我们报告了一例真性动脉瘤患者的病例，该患者最初在我们机构被诊断为假性动脉瘤；我们回顾了关于这一困难诊断的文献，并概述了每个临床实体的特征性表现。