Discussion:
The left ventricular free wall rupture (LVFWR) after MI decreased drastically in the current era due to the advancement of effective early revascularization strategies. Sudden cardiac death is a common sequel of LVFWR, however, in some cases, it can be contained by the superimposing adherent pericardium resulting in the formation of the pseudoaneurysm. The pseudoaneurysm communicates with the LV cavity by a narrow neck, whose diameter is less than 50% of the maximum internal dimensions of an aneurysm.1 Whereas, LV true aneurysm develops due to scar thinning of the myocardial wall after MI. It contains all the three layers of LV i.e endocardium, myocardium, and epicardium, and has a wide neck, smooth margins. The posterolateral wall is the most common location for LV pseudoaneurysm , whereas, a true aneurysm, located commonly in the apicoanterior wall. TTE is used as an initial diagnostic modality for the assessment of heart after MI. It not only helps in diagnosis, but also helps in determining the location and extent of the lesion. Due to its high tendency to expand and rupture, early surgical intervention is recommended in LV pseudoaneurysm. Our case had developed a giant LV psudoaneurysm four weeks after the development of MI which was successfully managed by the surgical intervention.
Reference :
Eren E, Bozbuga N, Toker ME, et al. Surgical treatment of post-infarction left ventricular pseudoaneurysm: a two-decade experience. Tex Heart Inst J 2007;34:47–51.
Legends :
Figure 1 - Apical four chamber view showing an apical pseudoaneurysm (red arrow) with narrow neck (green arrow). RA,Right atrium; RV, Right ventricle; LA, Left ventricle; LV, Left ventricle.
Figure 2 - Colour Doppler in apical four chamber view showing a free blood flow between left ventricular cavity and pseudoaneurysm (red arrow). RA,Right atrium; RV, Right ventricle; LA, Left ventricle; LV, Left ventricle.
Figure 3 – Surgical image showing a ruptured left ventricular apex (green arrow).
Video 1 : Apical four chamber view showing an apical pseudoaneurysm with narrow neck.
Video 2 : Colour Doppler in apical four chamber view showing a free blood flow between left ventricular cavity and pseudoaneurysm.