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(Circulation. 1999;100:329.)
© 1999 American Heart Association, Inc.

Images in Cardiovascular Medicine

Leaking Left Ventricular Pseudoaneurysm

Timothy Woods, MD; Thomas Grist, MD; Peter Rahko, MD

From the Section of Cardiology, Department of Medicine (T.W., P.R.), and the Department of Radiology (T.G.), University of Wisconsin Medical School, Madison.

Correspondence to Peter S. Rahko, MD, H6/334 CSC, Cardiology Section, University of Wisconsin Hospital, 600 Highland Ave, Madison, WI 53792. E-mail psr@medicine.wisc.edu

	Introduction

 
A56-year-old obese woman with severe steroid- and oxygen-dependent chronic obstructive pulmonary disease was thought to have experienced an apical myocardial infarction at home on the basis of review of history. When she was evaluated 3 months later at an outside hospital for recurrent chest pain, a cardiac catheterization revealed a total distal occlusion of the left anterior descending coronary artery, borderline occlusive disease in other coronary arteries, and an "apical aneurysm" by left ventriculography. She was continued on medical therapy.

During a subsequent hospital admission 6 months after the index infarction for recurrent atypical chest pain, an echocardiogram was reported to demonstrate a pseudoaneurysm with a moderate-size pericardial effusion. When the patient was seen shortly thereafter at our institution, a repeat echocardiogram (Figures 1 and 2) similarly demonstrated a probable left ventricular pseudoaneurysm with a large pericardial effusion. Subsequent pericardiocentesis with drainage of bloody aspirate suggested that the pseudoaneurysm was the source of effusion.

View larger version (111K): [in this window] [in a new window]   Figure 1. Apical 2-chamber view demonstrating apical pseudoaneurysm with laminated thrombus and pericardial effusion.

View larger version (101K): [in this window] [in a new window]   Figure 2. Off-axis apical 4-chamber view demonstrating pseudoaneurysm with narrow neck and pericardial effusion. RV indicates right ventricle; LV, left ventricle.

Given the patient's high surgical risk, it was elected to confirm the finding preoperatively with MRI (Figure 3).

View larger version (83K): [in this window] [in a new window]   Figure 3. Four-chamber view demonstrating apical pseudoaneurysm with thrombus within wall (curved arrow) and narrow neck of pseudoaneurysm (arrowheads). RA indicates right atrium; RV, right ventricle; LA, left atrium; and LV, left ventricle.

The patient subsequently underwent left ventricular endoaneurysmorrhaphy with . . . [Full Text of this Article]

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