Images in Clinical Medicine
Left Ventricular Pseudoaneurysm
N Engl J Med 2001; 344:1910June 21, 2001
- Article
Figure 1 Two months after an inferoposterior myocardial infarction, a 71-year-old woman presented to her physician with a one-week history of acutely worsening shortness of breath and exertional dyspnea. At the time of the initial event, a transthoracic echocardiogram demonstrated akinesis of the inferoposterior wall, with no other clinically significant abnormalities. Because of the patient's recurrent symptoms, two-dimensional echocardiography was repeated and revealed a large (approximately 5 by 9 cm) pseudoaneurysm (PSEUDO) in the posterior pericardial space that communicated with the left ventricle (LV) through a 3-cm defect in the posterior left ventricular free wall (Panel A). RV denotes right ventricle, and LA left atrium. Flow across the defect was confirmed by color Doppler and biplane ventriculography (Panels B and C, respectively). Emergency heart surgery was performed and revealed a large pseudoaneurysm within a thick, fibrous capsule of pericardium, extending from the apex to the base of the posterior wall. The pseudoaneurysm was incised, the ventricular defect (arrow in Panel C) was closed, and the capsule was partially resected. The patient made an uneventful recovery. In contrast to a true ventricular aneurysm, in which the wall is composed of myocardial scar tissue, the wall of a pseudoaneurysm is composed of thick fibrous tissue and pericardium. Pseudoaneurysms result from rupture of the left ventricle.
Andrew Burger, M.D.
Howard B. Sherman, M.D.
Beth Israel Deaconess Medical Center, Boston, MA 02215
