Ducloux G, Warembourg H, Laurent J M, Folliot J P, Bertrand M, Caron C, Soots G
Arch Mal Coeur Vaiss. 1982 Sep;75(9):1055-60.
Over a 10 year period, four cases of post myocardial infarction pseudo-left ventricular aneurysm were observed, two directly arising from the infarct (postero diaphragmatic patients had pseudo-aneurysms which arose inferiorly from true anteroapical aneurysms and underwent surgical resection. Apart from the histological features, a certain number of diagnostic signs merit review: --A clinical course marked by a number of phases (myocardial infarction--pericardial syndrome--true aneurysm complicated or not by arrhythmias--period of stabilisation followed by deterioration due to rapid progression of cardiac failure). -- "Angiographic-like" ultrasonic and isotopic methods complement left ventriculography which confirms the parietal aneurysm and may show three very suggestive signs of pseudo-aneurysm: a narrow communication with the true aneurysm; delayed and prolonged filling of the bulge; inferior extension with localization by pericardial adhesions. Surgery is imperative, the main problem being the extent of resection of the true aneurysm. This is related to the rigid or calcific character of the neck of the pseudo-aneurysm.
在10年期间,观察到4例心肌梗死后假性左心室动脉瘤,其中2例直接起源于梗死灶(后膈面患者的假性动脉瘤起源于真正的心尖前壁动脉瘤下方,并接受了手术切除)。除了组织学特征外,一些诊断征象值得回顾:——临床病程有多个阶段(心肌梗死——心包综合征——真性动脉瘤,有无心律失常并发症——稳定期,随后因心力衰竭快速进展而恶化)。——“类血管造影”的超声和同位素方法补充了左心室造影,后者可证实壁内动脉瘤,并可能显示出三个非常提示假性动脉瘤的征象:与真性动脉瘤的狭窄通道;膨出部分延迟且持久的充盈;通过心包粘连定位的向下延伸。手术势在必行,主要问题是真性动脉瘤的切除范围。这与假性动脉瘤颈部的僵硬或钙化特征有关。