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Asian Cardiovasc Thorac Ann 2008;16:179-180
© 2008 Asia Publishing EXchange Ltd

IMAGES IN CARDIOTHORACIC MEDICINE AND SURGERY

Postinfarction Giant Pseudoaneurysm in the Inferior Wall of the Left Ventricle

Mitsugu Ogawa, MD, Kiyoshi Doi, MD, Keitarou Koushi, MD, Hirotoshi Itoh, MD1, Tsunehiko Nishimura, MD1, Hitoshi Yaku, MD

Department of Cardiovascular and Thoracic Surgery
1 Department of Radiology Kyoto Prefectural University of Medicine Kyoto, Japan

For reprint information contact: Mitsugu Ogawa, MD, Tel: 81 75 251 5752, Fax: 81 75 257 5910, Email: m-ogawa{at}koto.kpu-m.ac.jp, Department of Cardiovascular and Thoracic Surgery, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto 602-8566, Japan.

A 66-year-old woman underwent emergency catheter-based revascularization of the occluded right coronary artery at a local hospital. On the following day, she had cardiac tamponade due to an oozing rupture of the left ventricle (LV) and needed a pericardiocentesis. Six months later, follow-up catheterization revealed a giant aneurysm larger than LV volume in the inferior wall of the LV (Figure 1Go).


Figure 1
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  		Figure1. Left ventriculography revealing a multilocular giant aneurysm larger than left ventricular volume (LV=left ventricle, AN=aneurysm)

 
Delayed-enhanced magnetic resonance imaging (DE-MRI) revealed a complete transmural myocardial defect in the inferior wall (Figure 2Go).


Figure 2
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  		Figure 2. DE-MRI demonstrating a complete transmural myocardial defect in the inferior wall (A) long-axis image, (B) short-axis image; the aneurysmal wall is very thin and hyperenhanced; the other territories are not hyperenhanced at all.

 
At operation, 20 horizontal mattress sutures were placed around the opening of the aneurysm, taking care not to damage the mitral annulus and the papillary muscle, which were in close proximity to the aneurysmal opening. An ellipsoidal patch of a trimmed HemashieldTM woven graft was used to tightly secure the opening. The postoperative course was uneventful.





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