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Double bubble trouble: a case of sub-epicardial aneurysms
Jecco Ani Babu1, Dillip Kumar Mishra1, Krishnaswamy Chandrasekaran2,3
1Department of CTVS, Apollo Hospitals, Greams Road, Chennai, 600006 India.
Indian Journal of Thoracic and Cardiovascular Surgery
|June 19, 2025
Summary
Sub-epicardial aneurysms, precursors to potentially fatal pseudo-aneurysms (PSA), pose diagnostic challenges. Advanced echocardiography aids in differentiating these from true aneurysms, guiding critical management decisions.
Area of Science:
- Cardiology
- Medical Imaging
- Vascular Surgery
Background:
- Sub-epicardial aneurysms are rare cardiac conditions that can lead to life-threatening complications like cardiac tamponade and rupture.
- Coronary artery disease is a significant comorbidity associated with these aneurysms.
- Accurate differentiation between true aneurysms and pseudo-aneurysms (PSA) is crucial for effective patient management.
Observation:
- A case of a 42-year-old female with two large sub-epicardial aneurysms and coronary artery disease is presented.
- Initial diagnosis suggested true aneurysms, highlighting diagnostic challenges.
- Transthoracic echocardiography demonstrated limitations in distinguishing PSA from true aneurysms.
Findings:
- Specific echocardiographic criteria, including neck-to-sac diameter ratio (<0.5) and wall thickness reduction (>50%), can aid in differentiation.
- Transesophageal echocardiography with bi-plane and 3D imaging offers improved characterization of outpouchings.
- Urgent surgical intervention is recommended for left ventricle (LV) PSA within 3 months post-myocardial infarction due to unpredictable rupture risk.
Implications:
- Enhanced echocardiographic techniques are vital for accurate diagnosis and surveillance of sub-epicardial aneurysms.
- Timely differentiation between true and pseudo-aneurysms is critical for surgical decision-making.
- Management strategies must consider the timing of associated myocardial infarction to mitigate rupture risk.
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