Surgical Treatment of Postinfarction Left Ventricular Pseudoaneurysms
DOI:
https://doi.org/10.1532/HSF98.20061042Abstract
Objective. Left ventricular pseudoaneurysm is a rare but serious complication of acute myocardial infarction. It is under debate whether surgical intervention is mandatory in asymptomatic patients. The aim of this report was to present our experience based on surgical treatment and midterm outcomes of patients with postinfarction left ventricular pseudoaneurysm.
Methods. Eight consecutive patients who underwent left ventricular pseudoaneurysm operation between January 1, 1995, and January 1, 2006, were included in the study. There were 5 male and 3 female patients. Mean age was 62.87 ± 5.03 years. All patients had echocardiography and coronary angiography before the operation. Two anterior and 6 posterior pseudoaneurysms were detected. Left ventricular pseudoaneurysm was repaired with a synthetic patch by the remodeling ventriculoplasty method of Dor in all patients. Coronary revascularization was performed if necessary. Preoperative, operative, and postoperative data were collected from the patient cohorts.
Results. The mean duration from myocardial infarction to diagnosis of the ventricular septal rupture was 13.5 ± 12 days. Additional coronary artery bypass surgery was performed with a median of 1.2 grafts in 5 patients (62.5%). The mean postoperative mechanic ventilator support time was 20.12 ± 29.22 hours. Overall 30-day mortality was 12.5% with 1 patient death. The mean intensive care unit stay was 3.75 ± 2.1 days. The late mortality rate was 12.5%. In the follow-up period (mean, 30.66 ± 16.86 months), of the 6 patients who were alive, 5 were in New York Heart Association class I or II and 1 was in class III because of pre-existing low left ventricular ejection fraction. Transthoracic echocardiography showed good left ventricular configurations without a false aneurysm together with increases in the ejection fractions.
Conclusion. Prompt diagnosis and early surgical intervention is essential for patients with large or expanding left ventricular pseudoaneurysms due to the high propensity of fatal rupture. Associated coronary artery bypass grafting may reduce early mortality of patients with left ventricular pseudoaneurysm by resuscitating the ischemic myocardium.
References
Brown SL, Gropler RJ, Harris KM. 1997. Distinguishing left ventricular aneurysm from pseudoaneurysm. A review of the literature. Chest 111:1403-9.nCsapo K, Voith L, Szuk T, Edes I, Kereiakes DJ. 1997. Postinfarction left ventricular pseudoaneurysm. Clin Cardiol 20:898-903.nFigueras J, Cortadellas J, Domingo E, Rodes S, Castell J, Soler J. 2001. Survival following self-limited left ventricular free wall rupture during myocardial infarction. Management differences between patients with or without pseudoaneurysm formation. Int J Cardiol 79:103-11.nFrances C, Romero A, Grady D. 1998. Left ventricular pseudoaneurysm. J Am Coll Cardiol 32:557-61.nHirasawa Y, Miyauchi T, Sawamura T, Tayika H. 2004. Giant left ventricular pseudoaneurysm after mitral valve replacement and myocardial infarction. Ann Thorac Surg 78:1823-5.nKoçak H, Becit N, Ceviz M, Ünlü Y. 2003. Left ventricular pseudoaneurysm after myocardial infarction. Heart Vessels 18:160-2.nKomeda M, David TE. 1993. Surgical treatment of postinfarction false aneurysm of the left ventricle. J Thorac Cardiovasc Surg 106:1189-91.nMoreno R, Gordillo E, Zamorano J, et al. 2003. Long term outcome of patients with postinfarction left ventricular pseudoaneurysm. Heart 89:1144-6.nMilojevic P, Nescovic V, Vucovic M, Nezic D, Djukanovic B. 2004. Surgical repair of a leaking double postinfarction left ventricular pseudoaneurysm. J Thorac Cardiovasc Surg 128:765-7.nPretre R, Linka A, Jenni R, Turina MI. 2000. Surgical treatment of acquired left ventricular pseudoaneurysms. Ann Thorac Surg 70:53-7.nRittenhouse EA, Sauvage LR, Mansfield PB, Smith JC, Davis CC, Hall DG. 1979. False aneurysm of the left ventricle. Report of four cases and review of surgical management. Ann Surg 189:409-15.nStevenson WG, Linssen GC, Havenith MG, Brugada P, Wellens HJ. 1989. The spectrum of death after myocardial infarction: a necropsy study. Am Heart J 118:1182-8.nVarvarigos N, Koletsis E, Zafiropoulos A, Papaioannou H, Migdalis I. 2005. A case of left ventricular pseudoaneurysm with long survival and congestive heart failure as first presentation. Case report and review of the literature. Med Sci Monit 11:CS69-73.nYeo TC, Malouf JF, Oh JK, Seward JB. 1998. Clinical profile and outcome in 52 patients with cardiac pseudoaneurysm. Ann Intern Med 128:299-305.nYeo TC, Malouf JF, Reeder GS, Oh JK. 1999. Clinical characteristics and outcome in postinfarction pseudoaneurysm. Am J Cardiol 8:592-5, A8.n
