Roa-Castro Víctor Hugo, Molina-Bello Ervin, Valenzuela-Suárez Hector, Rotberg-Jagode Tobías, Espinola-Zavaleta Nilda
Department of Clinical Cardiology, The American British Cowdray Medical Center IAP, Campus Observatorio, Sur 136 No. 116, Colonia Las Americas, Delegación Alvaro Obregón, 01120 Mexico City, DF, Mexico.
Case Rep Vasc Med. 2012;2012:728602. doi: 10.1155/2012/728602. Epub 2012 Mar 26.
Pseudoaneurysm of the left ventricle is rare and may occur as a result of transmural myocardial infarction. The course of rupture after acute myocardial infarction varies from a catastrophic event, with an acute tear leading to immediate death (acute rupture), or slow and incomplete tear leading to a late rupture (subacute rupture). Incomplete rupture may occur when the thrombus and haematoma together with the pericardium seal the rupture of the left ventricle and may develop into a pseudoaneurysm. Early diagnosis and treatment is essential in this condition. Two-dimensional color Doppler echocardiography is the first-choice method for most patients with suspected left ventricular pseudoaneurysm (LVP) and suggests left ventricular rupture in 85% to 90% of patients. We report the case of an 87-year-old woman presenting with symptoms and findings of myocardial infarction and left ventricular free wall rupture with a pseudoaneurysm formation diagnosed by echocardiography and confirmed on CT, MRI, and NM. She received only intense medical treatment, because she refused surgery with a favorable outcome. After 24-month followup, she is in NYHA functional class II. The survival of this patient is due to the contained pseudoaneurysm by dense pericardial adhesions, related to her previous coronary bypass surgery.
左心室假性动脉瘤较为罕见，可能是透壁性心肌梗死的结果。急性心肌梗死后的破裂过程各不相同，从灾难性事件，即急性撕裂导致立即死亡（急性破裂），到缓慢且不完全的撕裂导致延迟破裂（亚急性破裂）。当血栓、血肿与心包共同封闭左心室破裂口时，可能会发生不完全破裂，并可能发展为假性动脉瘤。对于这种情况，早期诊断和治疗至关重要。二维彩色多普勒超声心动图是大多数疑似左心室假性动脉瘤（LVP）患者的首选检查方法，85%至90%的患者通过该检查提示左心室破裂。我们报告了一例87岁女性病例，该患者表现出心肌梗死的症状和体征，经超声心动图诊断为左心室游离壁破裂并形成假性动脉瘤，CT、MRI和核医学检查进一步证实。由于患者拒绝手术，她仅接受了强化药物治疗，结果良好。经过24个月的随访，她的心功能分级为纽约心脏协会（NYHA）II级。该患者得以存活是因为致密的心包粘连包裹了假性动脉瘤，这与她之前接受的冠状动脉搭桥手术有关。
