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Clinical Cardiology Sep 1995Ventricular aneurysms are circumscribed, thin-walled fibrous, noncontractile outpouchings of the ventricle. The majority are apically located, true aneurysms of the left... (Review)
Review
Ventricular aneurysms are circumscribed, thin-walled fibrous, noncontractile outpouchings of the ventricle. The majority are apically located, true aneurysms of the left ventricle (LV) that occur as a consequence of transmural myocardial infarction (MI). The precursor of aneurysm formation appears to be infarct expansion early after acute MI and occurrence generally relates to infarct size. The presence of underlying hypertension and the use of steroids and nonsteroidal antiinflammatory agents may promote aneurysm formation. The clinical sequelae include congestive heart failure (CHF), thromboembolism, angina pectoris, and ventricular tachyarrhythmias. Late rupture is a particular complication of false aneurysms in which the pericardium is the aneurysm wall. The diagnosis may be suspected by the clinical finding of a diffuse, pansystolic apical thrust, persistent ST-segment elevation on the electrocardiogram, and distortion of the cardiac silhouette on chest x-ray. This can be confirmed using echocardiography, radionuclide ventriculography, and cardiac catheterization. The latter has the additional advantage of being able to delineate the coronary anatomy. Management involves prevention, specific therapy for the various clinical manifestations, and surgery. Therapeutic interventions with thrombolytic agents, aspirin, heparin, and beta blockers that are applied early in the evolution of an MI may limit infarction size, thereby reducing the tendency toward infarct expansion and aneurysm formation. Patients with mild CHF can usually be controlled with the standard combination of angiotensin-converting enzyme inhibitors, diuretics, and digoxin. Thromboembolism is best prevented by anticoagulation with warfarin for at least 3 months after the acute MI. The choice of pharmacotherapy for ventricular tachyarrhythmias should be guided by electrophysiologic studies. The treatment of patients with angina pectoris utilizes conventional therapeutic modalities.(ABSTRACT TRUNCATED AT 250 WORDS)
Topics: Heart Aneurysm; Heart Ventricles; Humans; Myocardial Infarction; Prognosis
PubMed: 7489606
DOI: 10.1002/clc.4960180905 -
Kardiologia Polska 2023
Topics: Humans; Heart Aneurysm; Heart Ventricles
PubMed: 36573602
DOI: 10.33963/KP.a2022.0293 -
Diagnostic and Interventional Radiology... Jan 2023A cardiac outpouching (CO) is a protrusion in a heart chamber's internal anatomical lining. Most COs are clinically insignificant, but some are of vital importance,... (Review)
Review
A cardiac outpouching (CO) is a protrusion in a heart chamber's internal anatomical lining. Most COs are clinically insignificant, but some are of vital importance, requiring immediate surgery. Cross-sectional imaging findings of COs, such as location, morphology, size, and accompanying wall motion abnormalities, play an essential role in determining the correct diagnosis and appropriate clinical management. Therefore, radiologists should be familiar with them. This article reviews the key cross-sectional imaging findings and differential diagnoses of COs.
Topics: Humans; Heart Aneurysm; Heart; Heart Ventricles
PubMed: 36960184
DOI: 10.4274/dir.2022.221419 -
Multimedia Manual of Cardiothoracic... Feb 2020Left ventricular restoration surgery is a procedure designed to restore or remodel the left ventricle to its normal spherical shape and size in patients with akinetic...
Left ventricular restoration surgery is a procedure designed to restore or remodel the left ventricle to its normal spherical shape and size in patients with akinetic segments of the heart, secondary to either dilated cardiomyopathy or post‑infarction left ventricular aneurysm. In this video tutorial, we present the operative technique for left ventricular restoration in the case of a 61-year-old male who developed a large left ventricular aneurysm a few months after delayed presentation of an occluded left anterior descending artery and subsequent myocardial infarction.
Topics: Cardiac Surgical Procedures; Heart Aneurysm; Heart Ventricles; Humans; Male; Middle Aged; Myocardial Infarction
PubMed: 32191403
DOI: 10.1510/mmcts.2020.006 -
Journal of the American College of... Sep 1998Left ventricular (LV) pseudoaneurysms form when cardiac rupture is contained by adherent pericardium or scar tissue. Although LV pseudoaneurysms are not common, the... (Review)
Review
Left ventricular (LV) pseudoaneurysms form when cardiac rupture is contained by adherent pericardium or scar tissue. Although LV pseudoaneurysms are not common, the diagnosis is difficult and they are prone to rupture. We evaluated the clinical presentation, diagnostic accuracy of imaging modalities, results of therapy and prognosis of 290 patients with LV pseudoaneurysms. Most cases of LV pseudoaneurysm were related to myocardial infarction (particularly inferior wall myocardial infarction) and cardiac surgery. Congestive heart failure, chest pain and dyspnea were the most frequently reported symptoms, but >10% of patients were asymptomatic. Physical examination revealed a murmur in 70% of patients. Almost all patients had electrocardiographic abnormalities, but these were usually nonspecific ST segment changes; only 20% of patients had ST segment elevation. Although radiographic findings were also usually nonspecific, the appearance of a mass was present in more than one half of patients and may be an important clue to the correct diagnosis. Left ventricular angiography was the most definitive test and can be useful in planning surgery since concomitant coronary angiography can be performed. Regardless of treatment, patients with LV pseudoaneurysms had a high mortality rate, especially those who did not undergo surgery. Because the symptoms, signs, electrocardiographic abnormalities and radiographic findings seen in patients with LV pseudoaneurysms can be indistinguishable from those in patients with coronary disease alone, a high clinical index of suspicion is needed to avoid missing the diagnosis.
Topics: Aneurysm, False; Diagnosis, Differential; Diagnostic Imaging; Electrocardiography; Female; Heart Aneurysm; Heart Rupture; Humans; Male; Middle Aged; Survival Rate
PubMed: 9741493
DOI: 10.1016/s0735-1097(98)00290-3 -
The Canadian Journal of Cardiology Dec 2008
Topics: Autopsy; Canada; Dissection; Heart Aneurysm; Humans; Immunohistochemistry; Incidence; Survival Rate; Syphilis, Cardiovascular; United Kingdom
PubMed: 19068539
DOI: 10.1016/s0828-282x(08)70712-8 -
Texas Heart Institute Journal Oct 2017Different surgical techniques, each with its own advantages and disadvantages, have been used to reverse adverse left ventricular remodeling due to postinfarction left... (Review)
Review
Different surgical techniques, each with its own advantages and disadvantages, have been used to reverse adverse left ventricular remodeling due to postinfarction left ventricular aneurysm. The most appropriate surgical technique depends on the location and size of the aneurysm and the scarred tissue, the patient's preoperative characteristics, and surgeon preference. This review covers the reconstructive surgical techniques for postinfarction left ventricular aneurysm.
Topics: Cardiac Surgical Procedures; Heart Aneurysm; Heart Ventricles; Humans; Myocardial Infarction; Plastic Surgery Procedures; Ventricular Function, Left; Ventricular Remodeling
PubMed: 29259502
DOI: 10.14503/THIJ-16-6068 -
Annals of Noninvasive Electrocardiology... Sep 2019Mid-ventricular obstructive hypertrophic cardiomyopathy (MVOHCM) is an uncommon type of HCM. LV apical aneurysms are present in more than 20% MVOHCM cases and has been... (Review)
Review
Mid-ventricular obstructive hypertrophic cardiomyopathy (MVOHCM) is an uncommon type of HCM. LV apical aneurysms are present in more than 20% MVOHCM cases and has been identified as an independent predictor of potentially lethal arrhythmic events, including non-sustained or sustained ventricular tachycardia (VT), and ventricular fibrillation (VF), as well as SCD. Although the pathogenesis of LVA remains unknown, but it has been suggested that apical aneurysm may be secondary to the increased after-load and high apical pressure arising from significant pressure gradient of the midventricular obstruction. The scarred rim of the aneurysm and the adjacent areas of LV myocardial fibrosis and consequent apical oxygen-demand mismatch may be responsible for the formation of apical aneurysm. Recent electrophysiologic studies have demonstrated that the aneurysmal rim forms the primary culprit arrhythmogenic substrate for generation of monomorphic ventricular tachycardia leading to SCD, but the clinical significance of the size of aneurysm in relation to SCD remains unsettled. We summarized the clinical features of the patients with MVOHCM and apical aneurysms. Appropriate therapeutic interventions include ICD implantation, and early surgical intervention for gradient relief may be undertaken to relief the MVO.
Topics: Cardiomyopathy, Hypertrophic; Heart Aneurysm; Heart Ventricles; Humans
PubMed: 30737990
DOI: 10.1111/anec.12638 -
The Journal of Thoracic and... Feb 2006True congenital ventricular diverticulum and aneurysm in children are very uncommon. We report our experience to clarify the diagnosis and outcome of these little-known...
OBJECTIVE
True congenital ventricular diverticulum and aneurysm in children are very uncommon. We report our experience to clarify the diagnosis and outcome of these little-known entities.
METHODS
Twenty-two patients with congenital ventricular outpouchings were identified in our database from 1973 to 2004. Morphologic characteristics (localization, connection to a ventricle, contractility), histologic findings, and cardiac and/or extracardiac abnormalities were analyzed in all 22 patients. Cardiovascular events and clinical courses were reviewed.
RESULTS
Congenital ventricular diverticula (n = 16) were characterized by synchronal contractility and three myocardial layers on histologic examination. Two categories of congenital ventricular diverticulum could be identified with regard to their localization: apical and nonapical. Apical diverticula (n = 8) were always associated with midline thoracoabdominal defects and other heart malformations. Nonapical diverticula (n = 8) were always isolated defects. Congenital ventricular aneurysms (n = 6) were characterized by akinesis with paradoxical systolic motion, wide connection to the ventricle, fibrosis on histologic examination that appeared with high signal on T2 weighted magnetic resonance imaging, and absence of other heart or midline thoracoabdominal defects. The outcome was different in these two types of outpouchings: congential ventricular aneurysms were associated with adverse outcomes whereas the prognosis for congenital ventricular diverticula was good.
CONCLUSION
Congenital ventricular diverticulum and aneurysm are two distinct entities, with different histologic and morphologic characteristics and outcomes. Assessment of these differential characteristics is of importance for prenatal counseling.
Topics: Diagnosis, Differential; Diverticulum; Female; Heart Aneurysm; Heart Defects, Congenital; Heart Ventricles; Humans; Infant; Infant, Newborn; Male; Prognosis
PubMed: 16434275
DOI: 10.1016/j.jtcvs.2005.09.046 -
Texas Heart Institute Journal Sep 2022Left ventricular pseudoaneurysm is a rare disease; it is defined as a ventricular rupture contained by epicardium, pericardial adhesions, or both. It most frequently... (Review)
Review
Left ventricular pseudoaneurysm is a rare disease; it is defined as a ventricular rupture contained by epicardium, pericardial adhesions, or both. It most frequently occurs as a complication of acute myocardial infarction. Surgical treatment is recommended for pseudoaneurysms that are large or symptomatic and for those discovered less than 3 months after myocardial infarction. We report our experience with 2 patients who had left ventricular pseudoaneurysms discovered less than a week after inferior myocardial infarction. Both patients were middle-aged men with right coronary occlusion in whom the diagnoses were established by echocardiography during the first week after infarction. Because both patients were clinically stable, we opted to defer surgery until scarring could facilitate correction; this decision was based on a review of the literature showing that in-hospital mortality is higher with early surgery. The patients were monitored closely in the intensive care unit and were prescribed β-blockers and vasodilators. Both patients underwent left ventricular patch reconstruction with exclusion of the pseudoaneurysm and posterior septum; both received moderate inotropic support and prophylactic intra-aortic balloon pump assistance. Their postoperative courses were uneventful. In 5 prior reports describing 45 patients (13 with acute pseudoaneurysm [≤2 wk after infarction] and 32 with nonacute pseudoaneurysm), in-hospital mortality was 61.5% for patients in the acute group and 15.6% for the nonacute group (P = .0066). We recommend that clinicians consider deferring surgery for patients with stable acute left ventricular pseudoaneurysm to reduce the risks associated with early repair.
Topics: Aneurysm, False; Coronary Occlusion; Heart Aneurysm; Heart Ventricles; Humans; Male; Middle Aged; Myocardial Infarction; Vasodilator Agents
PubMed: 36194723
DOI: 10.14503/THIJ-20-7462