Yoshimaru K, Momose A, Sato H, Nishitani H, Naka M, Hiramatsu K, Niwa A, Abe F
Department of Internal Medicine, Asama General Hospital, Saku.
J Cardiol. 1989 Jun;19(2):615-25.
A 76-year-old man had an extensively calcified left ventricular pseudoaneurysm which was a sequela of acute myocardial infarction suffered 22 years ago. He experienced acute anterolateral myocardial infarction in January 1964. In March 1964, the presence of a left ventricular aneurysm was suspected by chest radiography and fluoroscopy. He was, however, in good health since then. In April 1986, when he was admitted for treatment of acute bronchitis, a large calcified density was found in the left ventricular region on chest radiography. The electrocardiogram was compatible with an old anterolateral myocardial infarction. Two-dimensional echocardiography showed an immobile portion of the left ventricle which contained "moya-moya" (sluggish, smoky) echoes. A saccular aneurysm of the left ventricle was confirmed by radioisotope cardiac pool scans, reconstruction CT and left ventriculography. Due to the poor general condition of the patient, we followed his course without surgery. He died in October 1986. At autopsy, the pseudoaneurysm was markedly calcified, and its wall was adherent to the parietal pericardium. Histologically, the pseudoaneurysmal structure turned out to be a pseudoaneurysm since the saccular wall contained only scar tissue but no myocardial cells. This is a very rare case of a patient with a left ventricular pseudoaneurysm who survived for 22 years after its occurrence.
一名76岁男性患有广泛钙化的左心室假性动脉瘤，这是22年前急性心肌梗死的后遗症。他于1964年1月发生急性前侧壁心肌梗死。1964年3月，胸部X线摄影和荧光透视怀疑存在左心室动脉瘤。然而，从那时起他一直身体健康。1986年4月，当他因急性支气管炎入院治疗时，胸部X线摄影发现左心室区域有一大块钙化密度影。心电图与陈旧性前侧壁心肌梗死相符。二维超声心动图显示左心室有一个固定不动的部分，其中含有“烟雾状”（缓慢、模糊）回声。放射性核素心血池扫描、重建CT和左心室造影证实了左心室囊状动脉瘤。由于患者全身状况较差，我们未进行手术，而是对其病情进行随访。他于1986年10月去世。尸检时，假性动脉瘤明显钙化，其壁与心包壁层粘连。组织学检查显示，由于囊状壁仅含瘢痕组织而无心肌细胞，该假性动脉瘤结构确实为假性动脉瘤。这是一例非常罕见的左心室假性动脉瘤患者，发病后存活了22年。
