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Circulation. 2006;113:e748-e749
doi: 10.1161/CIRCULATIONAHA.105.568428
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(Circulation. 2006;113:e748-e749.)
© 2006 American Heart Association, Inc.

Images in Cardiovascular Medicine

Percutaneous Closure of a Left Ventricular Free-Wall Rupture Site

Patrick A. Gladding, MBCHB; Peter N. Ruygrok, MD, FRACP; Sally C. Greaves, FRACP; Ivor L. Gerber, , MD, FRACP; Andrew W. Hamer, FRACP

From Green Lane Cardiovascular Service at Auckland City Hospital, (P.G., P.R., S.G., I.G.), and Nelson Hospital (A.H.), Auckland, New Zealand.

Correspondence to Dr Patrick Gladding, Auckland City Hospital, Park Rd, Grafton, Auckland 1005, New Zealand. E-mail patrickg{at}adhb.govt.nz

An 86-year-old woman who lived independently was referred for consideration of percutaneous closure of a left ventricular free wall rupture site. Ten years earlier, she had undergone aortic valve replacement with a Carpentier-Edwards bioprosthesis (Edwards Lifesciences, Irvine, Calif) and received a single saphenous vein graft to the right coronary artery. Five years later, at the age of 81, she had an inferolateral myocardial infarction and an acute rupture of the left ventricular free wall. The resultant false aneurysm appeared to be small and contained (because of adhesions) and was managed conservatively.

Over the subsequent 4 years, she had increasing symptoms of heart failure with several hospital admissions, and there was radiographic (Figure, A) and echocardiographic evidence of increasing size of the false aneurysm, with dimensions of 6.5x4.5x8.5 cm (Figure, E). It had a focal neck, measuring 8 mm in diameter.


Figure 1175131
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  		A, Chest radiograph demonstrates a large, calcified circular mass adjacent to the left ventricle, with an elevated right hemidiaphragm and right pleural thickening. B, Angiographic view demonstrates contrast flow into large blind sac. Note volume/size of pseudoaneurysm compared with left ventricle and calcified wall. C, Amplatzer septal occluder in situ at the neck of the left ventricular pseudoaneurysm. Note contrast flow is nearly occluded. D, Completed procedure; Amplatzer septal occluder in situ. Procedure time, 82 minutes. E, Two-dimensional echocardiographic image showing neck of left ventricular aneurysm. F, Color flow Doppler echocardiographic image of aneurysm neck. G, Two-dimensional echocardiographic image shows Amplatzer device in situ. H, Color flow Doppler echocardiographic image of Amplatzer device in situ.

Cardiac catheterization was undertaken and a left ventricular angiogram was performed (Figure, B), demonstrating a large, calcified, egg-shaped false aneurysm with a narrow neck. Closure of the defect was then successfully undertaken with the patient under local anesthesia, using transthoracic echocardiographic guidance and fluoroscopy. A 12-mm Amplatzer septal occluder (AGA Medical Corporation, Golden Valley, Minn) was deployed through an 8F delivery sheath and advanced into the false aneurysm retrogradely from the right femoral artery, crossing the bioprosthetic aortic valve. A subsequent angiogram showed the defect to be successfully occluded with only a trivial residual leak (Figure, C and D), which had completely sealed on echocardiography (Figure, G and H). This report describes a rare combination of circumstances that permitted successful percutaneous treatment.


*    Acknowledgments
 
Disclosures

None.


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Percutaneous Closure of a False Aneurysm of the Right Ventricle in a Congenital Heart Disease Patient
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