Brennan Stephen, Sulong Saadah, Barrett Matthew
Department of Cardiology, St. Vincent's University Hospital, Elm Park, Dublin 4, D04 T6F4, Ireland.
Eur Heart J Case Rep. 2021 Jul 7;5(7):ytab203. doi: 10.1093/ehjcr/ytab203. eCollection 2021 Jul.
Left ventricular pseudoaneurysm (LVP) is an uncommon but serious mechanical complication of acute myocardial infarction (AMI). The immediate medical complications of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) are well recognized, but its indirect effect on patients and healthcare systems is potentially less perceivable.
In this report, a 72-year-old man who was anxious about attending hospital during the SARS-CoV-2 pandemic was eventually found to have a total right coronary artery occlusion after a delayed emergency department presentation. He ultimately developed severe symptomatic heart failure and cardiac magnetic resonance imaging (CMR) revealed that a large LVP with concomitant severe ischaemic mitral regurgitation had evolved from his infarct. The patient was successfully discharged home after the surgical replacement of his mitral valve and repair of his LVP.
This case highlights a salient downstream effect of Coronavirus disease 2019 (COVID-19): the delay in presentation, diagnosis, and management of common treatable conditions such as AMI. It also underscores the importance of non-invasive multimodal imaging on the timely identification of the mechanical complications of AMI. In particular, CMR can play a crucial role in the characterization and management of LVP.
左心室假性动脉瘤（LVP）是急性心肌梗死（AMI）一种罕见但严重的机械性并发症。严重急性呼吸综合征冠状病毒2（SARS-CoV-2）的直接医学并发症已广为人知，但其对患者和医疗系统的间接影响可能较难察觉。
在本报告中，一名72岁男性在SARS-CoV-2大流行期间因担心前往医院，最终在急诊科延迟就诊后被发现右冠状动脉完全闭塞。他最终发展为严重的症状性心力衰竭，心脏磁共振成像（CMR）显示，其梗死部位演变成了一个伴有严重缺血性二尖瓣反流的大型LVP。在接受二尖瓣置换术和LVP修复术后，患者成功出院回家。
本病例突出了2019冠状病毒病（COVID-19）一个显著的下游效应：延迟常见可治疗疾病（如AMI）的就诊、诊断和管理。它还强调了非侵入性多模态成像在及时识别AMI机械性并发症方面的重要性。特别是，CMR在LVP的特征描述和管理中可以发挥关键作用。
