Inoue Takahiro, Hashimoto Kazuhiro, Bando Ko, Yoshitake Michio
Department of Cardiac Surgery, The Jikei University, Minato-ku, Tokyo, Japan
Department of Cardiac Surgery, The Jikei University, Minato-ku, Tokyo, Japan.
Interact Cardiovasc Thorac Surg. 2015 Jul;21(1):137-9. doi: 10.1093/icvts/ivv086. Epub 2015 Apr 16.
Left ventricular pseudo-false aneurysms are a very rare complication of myocardial infarction. Occasionally, they will perforate into the right ventricle. Their haemodynamic presentation is similar to postinfarction ventricular septal defect. Even with no early clinical symptoms, they can lead to congestive heart failure or sudden fatal rupture. We report on a 67-year old man who developed a large left ventricular pseudo-false aneurysm that perforated into the right ventricle late after acute inferior myocardial infarction. He had undergone percutaneous coronary intervention to the right coronary artery in August 2013. During the surgery performed in July 2014, with only incision at the aneurysm, the small perforation to the right ventricle was closed directly and the large perforation to the left ventricle was closed with a bovine pericardial patch. Considering the late mechanical complications attendant to left ventricular remodelling, physicians should conduct careful long-term follow-up of patients with transmural myocardial infarction, even if previous percutaneous coronary intervention was successfully performed.
左心室假性室壁瘤是心肌梗死非常罕见的并发症。偶尔，它们会穿破进入右心室。其血流动力学表现类似于心肌梗死后室间隔缺损。即使没有早期临床症状，它们也可导致充血性心力衰竭或突然致命破裂。我们报告一名67岁男性，在急性下壁心肌梗死后晚期出现一个大的左心室假性室壁瘤并穿破进入右心室。他于2013年8月接受了右冠状动脉的经皮冠状动脉介入治疗。在2014年7月进行的手术中，仅在动脉瘤处切开，直接封闭了通向右心室的小穿孔，并用牛心包补片封闭了通向左心室的大穿孔。考虑到左心室重构伴随的晚期机械并发症，医生应对透壁性心肌梗死患者进行仔细的长期随访，即使先前的经皮冠状动脉介入治疗成功实施。
