Hironaka E, Kojima S, Hongo M, Fukaya Y, Katagiri Y, Hiramatsu K, Sekiguchi M
Central Clinical Laboratories, Shinshu University Hospital, Matsumoto, Japan.
J Am Soc Echocardiogr. 1997 Mar;10(2):192-6. doi: 10.1016/s0894-7317(97)70094-4.
A subepicardial aneurysm is a rare complication of myocardial infarction that sometimes causes a left to right shunt at the ventricular level. We report on echocardiographic observations in two recent cases of inferior myocardial infarction complicated by rupture of a subepicardial aneurysm into the right ventricle (RV). Two-dimensional and color flow Doppler images in several planes offered diagnostic characteristics of the lesion, including discontinuity of the myocardium at the neck of the aneurysm, a narrow neck relative to the diameter of the aneurysm, and a back and forth flow at the neck of the aneurysm. These techniques also provided new findings, such as a two-chambered structure of the aneurysm and a circular flow pattern within the inner aneurysmal cavity. In addition, color flow Doppler imaging showed multiple shunt flows from the aneurysm to the RV. Echocardiographically diagnosed abnormalities were verified by and successfully treated with surgery in both cases. In conclusion, echocardiography with color flow Doppler imaging may have the potential to diagnose the anatomic and hemodynamic condition of a subepicardial aneurysm.
心外膜下动脉瘤是心肌梗死的一种罕见并发症，有时会在心室水平导致左向右分流。我们报告了两例近期下壁心肌梗死合并心外膜下动脉瘤破裂入右心室（RV）的超声心动图观察结果。多个平面的二维和彩色多普勒血流图像提供了该病变的诊断特征，包括动脉瘤颈部心肌的连续性中断、相对于动脉瘤直径较窄的颈部以及动脉瘤颈部的往返血流。这些技术还提供了新的发现，如动脉瘤的双腔结构和动脉瘤腔内的环形血流模式。此外，彩色多普勒血流成像显示从动脉瘤到右心室的多个分流。两例患者经超声心动图诊断的异常均通过手术得到证实并成功治疗。总之，彩色多普勒血流成像超声心动图可能有潜力诊断心外膜下动脉瘤的解剖和血流动力学状况。
