Echocardiographic features of left ventricular aneurysm and false tendon in a patient with postinfarction...

Three years after the repair of a true left ventricular aneurysm, a 62-year-old man was admitted to our department for spontaneous angina pectoris and heart failure. The two-dimensional echocardiogram revealed a uniformly dilated left ventricle with a large apical aneurysm, in which a thin, continuous, band-like echogenic structure, extending from the interventricular septum to the antero-lateral wall could be visualized. That structure was initially interpreted as a left ventricular false tendon. Color Doppler flow imaging, however, showed a continuous, phasic flow crossing the band-like structure. Thus, the diagnosis of a huge apical pseudoaneurysm was made and subsequently confirmed by angiographic findings. In conclusion, left ventricular pseudoaneurysms may present themselves with unusual morphologic features. In patients with equivocal two-dimensional echocardiographic findings, color Doppler flow imaging is helpful in clarifying morphologic ambiguities and in identifying unsuspected flow abnormalities.