Banisauskaite Audra, Velavan Periaswamy, Hasleton Jonathan, Mediratta Neeraj, Arzanauskaite Monika, Binukrishnan Sukumaran
Radiology Department, Liverpool Heart and Chest Hospital NHS Foundation Trust, Thomas Drive, Liverpool L14 3PE, UK.
Radiology Department, Lithuanian University of Health Sciences, Eivenių str. 2, Kaunas 50161, Lithuania.
Eur Heart J Case Rep. 2021 Jul 18;5(7):ytab253. doi: 10.1093/ehjcr/ytab253. eCollection 2021 Jul.
Left ventricular (LV) pseudoaneurysm is a serious and rare complication of myocardial infarction (MI). It occurs when an injured myocardial wall ruptures and is contained by overlying adherent pericardium or scar tissue, most commonly it develops in patients with late presentation of MI and delayed revascularization.
A 64-year-old man presented to the emergency department with intermittent central chest pain radiating to back and neck and increasing on deep inspiration, which was considered to be of musculoskeletal origin for a week, but worsened despite medications. Electrocardiography showed features of ST-elevation MI; a circumflex artery occlusion was found on coronary angiogram and angioplasty was performed. Cardiovascular magnetic resonance (CMR) revealed features of healed lateral wall rupture with adherent parietal pericardium and the patient was managed conservatively. Two months later the patient returned with severe chest pain; echocardiogram and cardiac computed tomography showed significant interval progression of the pseudoaneurysm. Aneurysmectomy was performed, after which the patient recovered and had none of the previous symptoms since. Follow-up CMR study revealed improvement of LV systolic function.
A rare case of post-infarction LV pseudoaneurysm was reported. Multimodality imaging helped to detect and to differentiate this complication from the true aneurysm and to follow it up and plan the treatment. Conservative treatment was not effective in this case as the pseudoaneurysm progressed; aneurysmectomy helped to improve LV systolic function.
左心室假性动脉瘤是心肌梗死（MI）一种严重且罕见的并发症。当受损心肌壁破裂并被覆盖的粘连心包或瘢痕组织包裹时就会发生，最常见于心肌梗死延迟就诊和延迟血运重建的患者。
一名64岁男性因间歇性胸痛放射至背部和颈部，深吸气时加重，到急诊科就诊。一周来一直认为是肌肉骨骼源性疼痛，但尽管用药仍有加重。心电图显示ST段抬高型心肌梗死特征；冠状动脉造影发现回旋支动脉闭塞并进行了血管成形术。心血管磁共振成像（CMR）显示侧壁破裂愈合伴壁层心包粘连的特征，该患者接受了保守治疗。两个月后患者因严重胸痛再次就诊；超声心动图和心脏计算机断层扫描显示假性动脉瘤有明显进展。进行了动脉瘤切除术，术后患者康复，此后未再出现之前的症状。随访CMR研究显示左心室收缩功能有所改善。
报道了一例罕见的心肌梗死后左心室假性动脉瘤病例。多模态成像有助于检测该并发症，并将其与真性动脉瘤区分开来，还能对其进行随访并制定治疗方案。在本病例中，由于假性动脉瘤进展，保守治疗无效；动脉瘤切除术有助于改善左心室收缩功能。
