CASE REPORTS  CARDIAC PAPERS 

The Journal of Cardiovascular Surgery 1999 August;40(4):539-41

Copyright © 2000 EDIZIONI MINERVA MEDICA

lingua: Inglese

Posterior-septal pseudo-pseudoaneurysm with limited left-to-right shunt: an unexpected easy repair

Alessandrini F., De Bonis M., Lapenna E., Morelli M., Possati G. F.

From the Department of Cardiac Surgery “ A. Gemelli” University Hospital Catholic University, Rome, Italy

Car­diac rup­ture rep­re­sents a ­fatal com­pli­ca­tion of ­acute myo­car­dial infarc­tion ­within the ­first two ­weeks. In excep­tional ­cases, the post­in­farc­tion rup­ture of the myo­car­dium is not trans­mural but ­remains cir­cum­scribed ­within the ­wall ­itself as a ­cavity ­joined to the ­left ven­tricle ­through a ­narrow ­neck. ­This ­finding is usu­ally ­defined as ­pseudo-pseu­do­aneu­rysm. We ­report a ­rare ­case of post­in­farc­tion pos­te­rior ­pseudo-pseu­do­aneu­rysm of the ­left ven­tricle, per­fo­rated ­into the ­right ven­tricle. ­This ­unusual ­anatomy ­resulted, ­over a ­period of sev­eral ­years, by pro­gres­sive intra­mural dis­sec­tion of the sur­rounding ­necrotic myo­car­dium ­with ­late for­ma­tion of a ­large, par­tially ­fibrotic ­chamber, com­mu­ni­cating ­either ­with ­left and ­right ven­tri­cles. ­Despite cor­rect pre­op­er­a­tive diag­nosis was not ­achieved by 2D ech­o­car­di­og­raphy, ­pulsed Dop­pler and con­trast ven­tric­u­log­raphy, a suc­cessful sur­gical treat­ment was pos­sible ­with a ­really ­good out­come.