Pirzada Ashar, Styles Kim, Stewart Robbie
Division of Cardiology, Department of Medicine, Dalhousie University, 1796 Summer St, Room 2132, Halifax Infirmary, Halifax, NS B3H 3A7, Canada.
Eur Heart J Case Rep. 2023 Jan 3;7(1):ytac495. doi: 10.1093/ehjcr/ytac495. eCollection 2023 Jan.
Left ventricular pseudoaneurysm is a recognized, however, uncommon presentation of acute myocardial infarction in the current era. This is due to early reperfusion therapy for acute myocardial infarction. Left ventricular pseudoaneurysm after myocardial infarction can present in a variety of ways, including heart failure, chest pain, and dyspnoea.
We present a case of a 61-year-old male who presented with extremely atypical symptoms of dysphagia and weight loss due to a massive left ventricular pseudoaneurysm. Transthoracic echocardiogram and computed tomography revealed a large pseudoaneurysm causing mass effect on multiple gastrointestinal organs. Organic causes for dysphagia and weight loss were ruled out by gastroscopy. Surgical management was carried out but was ultimately unsuccessful.
Despite the heterogeneity in presentation for patients with left ventricular pseudoaneurysm, rapid diagnosis is important for management and prognosis. Diagnostic tools include transthoracic echocardiography, computed tomography, and cardiac magnetic resonance imaging. Management is usually surgical; however, there is some debate in the literature regarding conservative vs. surgical management for chronic pseudoaneurysms. More data are needed to determine optimal management strategies and prognosis for patients with left ventricular pseudoaneurysms.
左心室假性动脉瘤是一种已被认识到的疾病，然而在当今时代，它是急性心肌梗死的一种不常见表现形式。这是由于对急性心肌梗死采用了早期再灌注治疗。心肌梗死后的左心室假性动脉瘤可通过多种方式表现出来，包括心力衰竭、胸痛和呼吸困难。
我们报告一例61岁男性患者，因巨大的左心室假性动脉瘤出现吞咽困难和体重减轻等极不典型的症状。经胸超声心动图和计算机断层扫描显示一个大的假性动脉瘤对多个胃肠道器官产生了占位效应。胃镜检查排除了吞咽困难和体重减轻的器质性病因。进行了手术治疗，但最终未成功。
尽管左心室假性动脉瘤患者的表现存在异质性，但快速诊断对于治疗和预后很重要。诊断工具包括经胸超声心动图、计算机断层扫描和心脏磁共振成像。治疗通常采用手术方式；然而，关于慢性假性动脉瘤的保守治疗与手术治疗，文献中存在一些争议。需要更多数据来确定左心室假性动脉瘤患者的最佳治疗策略和预后。
