Chandrashekar Rakshita, Konda Monoj Kumar, Gupta Vishal, Kalavakunta Jagadeesh K
Department of Cardiology, St John Hospital and Medical Center, Grosse Pointe, MI, USA.
Department of Internal Medicine, Western Michigan University School of Medicine, Kalamazoo, MI, USA.
Eur J Case Rep Intern Med. 2017 Jan 27;4(1):000518. doi: 10.12890/2016_000518. eCollection 2017.
Left ventricular pseudoaneurysm (LVPA) is associated with a significant mortality rate of up to 45% in the first year after diagnosis. It is a very rare entity and hence the true incidence and natural history are not clearly known. Clinical presentation varies widely and requires a high index of suspicion for diagnosis. We report the case of a 72-year-old woman with a remote history of left ventricular aneurysm repair during coronary bypass surgery who presented to the emergency department with acute onset of left-sided chest pain and a pulsatile chest wall swelling. She was haemodynamically stable but required an intravenous morphine drip for pain control. Contrast-enhanced computed tomography of the chest showed a large LVPA dissecting through the anterior chest wall. Surgical treatment was discussed with the patient but she opted in favour of comfort care. She died 5 days later from complete rupture of the LVPA. With this report, we aim to raise the level of awareness of LVPA that could anatomically expand and rupture. Early diagnosis and timely surgical intervention is the treatment of choice.
It is important to recognize left ventricular pseudoaneurysm as a rare cause of sudden onset chest pain in a patient with history of myocardial infarction with/without coronary artery bypass grafting and presenting with a pulsatile chest wall mass on physical examination.Echocardiography is usually used for diagnosis, which is confirmed by CT or MRI of chest, while open surgical or percutaneous closure are the available treatment options.Mortality rates are very high even with surgical treatment in these complex patients.
左心室假性动脉瘤（LVPA）在诊断后的第一年死亡率高达45%。它是一种非常罕见的病症，因此其真实发病率和自然病程尚不清楚。临床表现差异很大，诊断需要高度的怀疑指数。我们报告一例72岁女性病例，该患者有冠状动脉搭桥手术期间左心室动脉瘤修复的既往史，因急性左侧胸痛和搏动性胸壁肿胀就诊于急诊科。她血流动力学稳定，但需要静脉滴注吗啡以控制疼痛。胸部增强计算机断层扫描显示一个大的LVPA穿破前胸壁。与患者讨论了手术治疗，但她选择了姑息治疗。她在5天后因LVPA完全破裂死亡。通过本报告，我们旨在提高对可解剖性扩张和破裂的LVPA的认识水平。早期诊断和及时手术干预是首选治疗方法。
重要的是要认识到左心室假性动脉瘤是心肌梗死患者突发胸痛的罕见原因，无论有无冠状动脉搭桥手术史，体格检查发现搏动性胸壁肿块。超声心动图通常用于诊断，胸部CT或MRI可确诊，而开放手术或经皮封堵是可用的治疗选择。即使对这些复杂患者进行手术治疗，死亡率也非常高。
