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Percutaneous closure of left ventricular pseudoaneurysm
Yuriy Dudiy1, Vladimir Jelnin, Bryce N Einhorn
1Lenox Hill Heart and Vascular Institute of New York, 130 East 77th St., New York, NY 10021-10075, USA.
Insights
Percutaneous closure effectively treats left ventricular pseudoaneurysm in high-risk patients. This minimally invasive approach offers a feasible alternative to surgery, improving patient functional class.
Area of Science:
- Cardiology
- Interventional Cardiology
- Cardiac Surgery
Background:
- Left ventricular pseudoaneurysm (LVPA) is a rare but severe complication following myocardial infarction or cardiac surgery.
- Surgical intervention is the standard treatment, but percutaneous closure is emerging for high-risk patients.
- Existing literature on percutaneous LVPA treatment consists mainly of single case reports.
Purpose of the Study:
- To evaluate the feasibility and outcomes of percutaneous closure for left ventricular pseudoaneurysms.
- To present the first series of percutaneous treatments for LVPA.
Main Methods:
- Retrospective analysis of 9 procedures in 7 consecutive patients (ages 51-83) undergoing percutaneous LVPA repair.
- Patients were selected due to high surgical risk from comorbidities.
- Multiple imaging modalities were utilized for pre-procedural planning, intra-procedural guidance, and post-procedural assessment.
Main Results:
- Successful percutaneous repair of left ventricular pseudoaneurysms in all 7 patients.
- Average fluoroscopy time was 36.5±24.0 minutes.
- Follow-up (3-32 months) showed significant functional improvement, with all patients improving by at least one NYHA class and 4 improving by two classes.
Conclusions:
- Transcatheter closure of left ventricular pseudoaneurysm is a viable alternative for patients unsuitable for surgery.
- Comprehensive imaging is crucial for successful planning and execution of these complex procedures.
Background:
Left ventricular pseudoaneurysm is a rare but serious complication from myocardial infarction and cardiac surgery. Although standard treatment is surgical intervention, percutaneous closure of left ventricular pseudoaneurysm has become an option for high-risk surgical candidates. Experience with percutaneous treatment is limited to a few single case reports. This is the first series of percutaneous treatment of the left ventricular pseudoaneurysms.
Methods And Results:
This is a retrospective analysis of 9 procedures of percutaneous repair of left ventricular pseudoaneurysm in 7 consecutive patients (ages 51 to 83 years, 6 men) completed in our Structural Heart Disease center from June 2008 to December 2010. All patients were considered as a high risk for surgery because of multiple comorbidities. Multiple imaging modalities were used before, during, and after the procedures to improve success and efficacy. The left ventricular pseudoaneurysms of all 7 patients were successfully repaired. Fluoroscopy time on average was 36.5±24.0 minutes (range, 12.4 to 75.7 minutes). All patients were followed up for a period ranging from 3 to 32 months after the procedure. Each patient improved by at least 1 New York Heart Association functional class, and 4 patients improved by 2 classes.
Conclusions:
Transcatheter closure of the left ventricular pseudoaneurysm is a feasible alternative for high-risk surgical candidates. The use of multiple imaging modalities is required for a detail planning and execution of the procedure.
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