Cardiovascular Division, Kawachi General Hospital, 1-31 Yokomakura, Higashi-Osaka, Osaka 578-0955, Japan.
J Cardiol. 2009 Oct;54(2):339-43. doi: 10.1016/j.jjcc.2009.01.010. Epub 2009 Mar 26.
A 62-year-old man presented to hospital with chest oppression. Coronary angiography revealed total occlusion of the right coronary artery and inferior myocardial infarction was diagnosed. He was treated by percutaneous coronary intervention with stenting for myocardial infarction. After four months, echocardiography revealed a huge aneurysm protruding below the inferior surface of the left ventricle. It was considered to be a pseudoaneurysm from the echocardiographic findings. The patient had no symptoms and he refused surgery, so progression of the aneurysm was monitored carefully. At seven months after revascularization, the aneurysm showed a marked increase in size, with a maximal diameter of 48 mm and orifice diameter of 22 mm. Accordingly, the patient agreed to undergo surgical excision. The aneurysm was resected and the defect was closed with a pericardial patch. Pathological examination revealed all of the myocardial elements in the aneurysm wall and thrombus in its lumen. In conclusion, this was a rare case of ventricular subepicardial aneurysm.
一位 62 岁男性因胸闷就诊于医院。冠状动脉造影显示右冠状动脉完全闭塞，并诊断为下壁心肌梗死。他接受了经皮冠状动脉介入治疗和支架置入术以治疗心肌梗死。四个月后，超声心动图显示左心室下表面有一个巨大的突出的动脉瘤。根据超声心动图的结果，考虑为假性动脉瘤。患者无症状且拒绝手术，因此密切监测动脉瘤的进展。再血管化后 7 个月，动脉瘤明显增大，最大直径为 48mm，口部直径为 22mm。因此，患者同意接受手术切除。切除了动脉瘤并用心包补片封闭了缺损。病理检查显示动脉瘤壁上有所有心肌成分和管腔内的血栓。总之，这是一例罕见的心室心外膜下动脉瘤。
