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Percutaneous closure of a left ventricular pseudoaneurysm in a high-risk surgical candidate
Biswajit Kar1, Gunjan Gholkar, Igor D Gregoric
1Department of Adult Cardiology, Texas Heart Institute at St. Luke's Episcopal Hospital, Houston, Texas 77030, USA. biswajit.kar@uth.tmc.edu
Insights
Percutaneous device closure successfully treated a left ventricular pseudoaneurysm in a high-risk patient. This minimally invasive technique offers a viable alternative to surgery for complex cardiac conditions.
Area of Science:
- Cardiology
- Interventional Cardiology
- Cardiac Surgery
Background:
- Left ventricular pseudoaneurysms are rare but serious complications, often requiring surgical intervention.
- Patients with multiple prior sternotomies present significant challenges for traditional surgical repair.
Observation:
- A 67-year-old male with coronary artery disease presented with dyspnea and chest pain.
- Computed tomographic angiography revealed a left ventricular pseudoaneurysm with a small ventricular leak.
- The patient had a history of three previous sternotomies, classifying him as high-risk for surgery.
Findings:
- Percutaneous device closure of the left ventricular pseudoaneurysm was performed using an AMPLATZER muscular ventricular septal defect occluder.
- The procedure, performed via the femoral vein, was technically challenging but successful.
- The patient was discharged the following day and remained asymptomatic at one-year follow-up.
Implications:
- This case demonstrates the feasibility of percutaneous closure for left ventricular pseudoaneurysms, particularly in high-risk patients.
- Transfemoral venous approach offers a novel, less invasive option compared to surgical repair.
- This technique may expand treatment options for patients unsuitable for conventional surgery.
Abstract:
Few cases of percutaneous device closure of a left ventricular pseudoaneurysm have been reported. We describe the case of a 67-year-old man with a history of coronary artery disease who presented with shortness of breath and chest pain. Computed tomographic angiography showed a left ventricular pseudoaneurysm that was filling from a small leak in the anterolateral aspect of the ventricle. The patient had undergone 3 previous sternotomies and was a high-risk candidate for surgical treatment of the pseudoaneurysm. Despite technical challenges, we closed the pseudoaneurysm percutaneously with use of a 6-mm AMPLATZER muscular ventricular septal defect occluder. The patient was released from the hospital the next day and was asymptomatic a year later.To our knowledge, this is the first report of the percutaneous closure of a left ventricular pseudoaneurysm via the femoral vein. We show that this manner of closure can be feasible in patients who have undergone multiple sternotomies and who are at high surgical risk.
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