Chodorowski Zygmunt, Anand Jacek Sein, Ciechanowicz Robert, Pawlaczyk Rafał, Jaśkiewicz Kazimierz
Katedra i Klinika Chorób Wewnetrznych, Geriatrii i Toksykologii, Akademii Medycznej w Gdańsku.
Przegl Lek. 2009;66(6):348-9.
Left ventricular pseudoaneurysm from myocardial infarction is rare but is associated with a high risk of rapid enlargement and rupture. This report describes a 57 year old woman with left ventricular pseudoaneurysm and delayed surgical repair. Seven weeks after myocardial infarction control transthoracic echocardiography revealed a inferolateral left ventricular pseudoaneurysm. Early surgical intervention was recommended but the patient refused hospitalization and surgical repair and continued every day home activity. The symptoms and signs were so mild that she was qualified to 1st class of NYHA classification and 1st class of CCS classification. Six weeks later-ventriculography confirmed the primary diagnosis. During heart surgery the pseudoaneurysm was incised, its fibrous wall with thrombus was resected and the ruptured left ventricular myocardium was satured. She had an uneventful postoperative course. Definitive diagnosis of the pseudoaneurysm was confirmed by histopathological evaluation of the excised left ventricular wall.
心肌梗死所致左心室假性动脉瘤较为罕见，但与快速扩大和破裂的高风险相关。本报告描述了一名57岁患有左心室假性动脉瘤且手术修复延迟的女性。心肌梗死后7周，经胸超声心动图检查发现左心室下壁假性动脉瘤。建议早期手术干预，但患者拒绝住院和手术修复，继续每日居家活动。其症状和体征非常轻微，符合纽约心脏协会（NYHA）心功能分级I级和加拿大心血管学会（CCS）心功能分级I级。六周后，心室造影证实了初步诊断。在心脏手术中，切开假性动脉瘤，切除带有血栓的纤维壁，并对破裂的左心室心肌进行缝合。术后过程顺利。通过对切除的左心室壁进行组织病理学评估，确诊为假性动脉瘤。
