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Pseudoaneurysm with left-to-right shunt in a patient with myocardial infarction: evaluation by three-dimensional

Hirofumi Maeba1, Yoko Miyasaka2, Ayako Kotaka2

  • 1Division of Cardiovascular Disease, Department of Medicine II, Kansai Medical University, 2-3-1 Shinmachi, Hirakata, Osaka, 573-1191, Japan. maebah@hirakata.kmu.ac.jp.

Journal of Medical Ultrasonics (2001)
|June 10, 2016
PubMed

Insights

Differentiating post-infarction pseudoaneurysms from true aneurysms is challenging. Three-dimensional transesophageal echocardiography (3D-TEE) effectively diagnosed a pseudoaneurysm with a left-to-right shunt in a myocardial infarction patient.

Area of Science:

  • Cardiology
  • Medical Imaging

Background:

  • Distinguishing between post-infarction left ventricular (LV) pseudoaneurysms and true aneurysms noninvasively presents a clinical challenge.
  • Acute decompensated heart failure can be a symptom of complex cardiac complications following myocardial infarction.

Purpose of the Study:

  • To highlight the diagnostic utility of advanced echocardiography in identifying a rare case of inferoposterior pseudoaneurysm with a significant left-to-right shunt.
  • To illustrate the differentiation between pseudoaneurysm and true aneurysm using specific imaging modalities.

Main Methods:

  • A 66-year-old female patient with a history of inferior acute myocardial infarction presented with heart failure.
  • Two-dimensional transthoracic echocardiography revealed an inferoposterior basal aneurysm with a narrow orifice and a pulmonary to systemic flow ratio (Qp/Qs) of 2.2:1, indicating a moderate left-right shunt.
  • Three-dimensional transesophageal echocardiography (3D-TEE) precisely visualized the orifice in the right ventricular basal area and confirmed a left-to-right shunt from the LV to the right ventricle.

Main Results:

  • Echocardiography identified an inferoposterior aneurysm with features suggestive of a shunt.
  • 3D-TEE provided definitive visualization of a perforated right ventricular basal area and a color jet indicating a left-to-right shunt.
  • The findings led to the diagnosis of an inferoposterior pseudoaneurysm resulting from myocardial infarction.

Conclusions:

  • Three-dimensional transesophageal echocardiography is crucial for accurately diagnosing post-infarction pseudoaneurysms, especially when differentiating from true aneurysms.
  • This case underscores the importance of advanced echocardiographic techniques in identifying complex cardiac sequelae of myocardial infarction, such as pseudoaneurysms with shunts.
  • Accurate diagnosis using 3D-TEE facilitates appropriate management strategies for patients with post-infarction complications.

Keywords:
Left-to-right shuntPseudoaneurysmThree-dimensional transesophageal echocardiography

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