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Hypertrophic cardiomyopathy-related left ventricular pseudoaneurysm: A case report

Katsuya Hashimoto1, Hiroyuki Yamamoto1,2, Atsushi Harada3

  • 1Department of Cardiovascular Medicine, Narita-Tomisato Tokushukai Hospital, Chiba, Japan.

Heliyon
|June 13, 2024
PubMed

Insights

This case study presents the first instance of hypertrophic cardiomyopathy-related left ventricular pseudoaneurysm (LVP) mimicking cardiac rupture. Early diagnosis and management of HCM-related LVP are critical for patient outcomes.

Area of Science:

  • Cardiology
  • Cardiovascular Surgery
  • Medical Imaging

Background:

  • Left ventricular pseudoaneurysm (LVP) is a rare but fatal complication of left ventricular rupture, distinct from true aneurysms often seen in hypertrophic cardiomyopathy (HCM).
  • Differentiating LVP from true aneurysms is critical due to differing natural histories and treatment strategies.
  • The incidence and management of HCM-related LVP remain largely unknown, necessitating further investigation.

Observation:

  • An 88-year-old male presented with chest pain, echocardiography revealed left ventricular hypertrophy and outflow tract obstruction.
  • Cardiac computed tomography angiography (CCTA) was crucial in diagnosing LVP with signs of impending cardiac rupture.
  • Despite medical management, the patient's condition deteriorated, leading to semi-urgent surgical repair.

Findings:

  • Surgical findings and subsequent pathology confirmed LVP with adjacent myocardial tissue consistent with HCM.
  • This represents the first reported case of HCM-related LVP presenting as impending cardiac rupture.
  • Postoperative hypotension was noted, and the patient ultimately died of non-occlusive mesenteric ischemia.

Implications:

  • This case underscores the importance of considering HCM-related LVP in patients with left ventricular outpouching.
  • CCTA plays a vital role in the diagnosis of LVP.
  • Accumulating data on the management of HCM-related LVP is essential for future clinical practice.
Abstract

Keywords:
Cardiac computed tomography angiographyHypertrophic cardiomyopathyLeft ventricular outpouchingLeft ventricular pseudoaneurysmMid-ventricular obstruction

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