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Posterior-septal pseudo-pseudoaneurysm with limited left-to-right shunt: an unexpected easy repair
F Alessandrini1, M De Bonis, E Lapenna
1Department of Cardiac Surgery, A. Gemelli University Hospital, Catholic University, Rome, Italy.
Abstract:
Cardiac rupture represents a fatal complication of acute myocardial infarction within the first two weeks. In exceptional cases, the postinfarction rupture of the myocardium is not transmural but remains circumscribed within the wall itself as a cavity joined to the left ventricle through a narrow neck. This finding is usually defined as pseudo-pseudoaneurysm. We report a rare case of postinfarction posterior pseudo-pseudoaneurysm of the left ventricle, perforated into the right ventricle. This unusual anatomy resulted, over a period of several years, by progressive intramural dissection of the surrounding necrotic myocardium with late formation of a large, partially fibrotic chamber, communicating either with left and right ventricles. Despite correct preoperative diagnosis was not achieved by 2D echocardiography, pulsed Doppler and contrast ventriculography, a successful surgical treatment was possible with a really good outcome.
Insights
This case report details a rare pseudo-pseudoaneurysm, a cardiac rupture complication after myocardial infarction. Surgical intervention proved successful for this unusual left ventricle perforation into the right ventricle.
Area of Science:
- Cardiology
- Cardiac Surgery
- Medical Imaging
Background:
- Cardiac rupture is a critical complication of acute myocardial infarction, typically occurring within two weeks.
- Pseudo-pseudoaneurysms are rare variants of postinfarction myocardial rupture, characterized by intramural cavities connected to a ventricle via a narrow neck.
Observation:
- A unique case of a posterior left ventricular pseudo-pseudoaneurysm, perforated into the right ventricle, is presented.
- This condition developed over years due to intramural dissection of necrotic myocardium, forming a fibrotic chamber communicating with both ventricles.
Findings:
- Preoperative diagnosis was challenging, with 2D echocardiography, pulsed Doppler, and contrast ventriculography failing to accurately identify the complex anatomy.
- Despite diagnostic limitations, successful surgical treatment was achieved, leading to a favorable patient outcome.
Implications:
- This case highlights the importance of considering rare cardiac pathologies even with inconclusive diagnostic imaging.
- Successful surgical management of complex pseudo-pseudoaneurysms underscores the potential for positive outcomes in challenging cardiovascular cases.
- Further research into advanced imaging techniques for diagnosing such rare cardiac anomalies is warranted.