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Left ventricular postoperative false aneurysm following apical venting.
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MedLine Citation:
PMID:  17090324     Owner:  NLM     Status:  PubMed-not-MEDLINE    
Abstract/OtherAbstract:
We report a case of false aneurysm of the left ventricle occurring subsequently to the placing of a vent sump line through the apex during an aortic valve procedure; the diagnosis was made twelve months later during a routine echocardiographic examination. The lesion was successfully repaired. This case recommend the use of other routes of venting in order to reduce the incidence of such complications.
Authors:
Federico Bizzarri; David Rose; Giacomo Frati; Luigi Muzzi
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Publication Detail:
Type:  Journal Article     Date:  2006-11-07
Journal Detail:
Title:  Journal of cardiothoracic surgery     Volume:  1     ISSN:  1749-8090     ISO Abbreviation:  -     Publication Date:  2006  
Date Detail:
Created Date:  2006-11-22     Completed Date:  2007-07-09     Revised Date:  2008-11-20    
Medline Journal Info:
Nlm Unique ID:  101265113     Medline TA:  J Cardiothorac Surg     Country:  England    
Other Details:
Languages:  eng     Pagination:  41     Citation Subset:  -    
Affiliation:
Dipartimento Cuore e Grossi Vasi Attilio Reale, Universita' degli Studi di Roma La Sapienza, Unita' Operativa di Cardiochirurgia, Polo Pontino, Via F,Faggiana 34, Latina, Italy. federico.bizzarri@uniroma1.it
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Journal Information
Journal ID (nlm-ta): J Cardiothorac Surg
ISSN: 1749-8090
Publisher: BioMed Central, London
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Copyright ? 2006 Bizzarri et al; licensee BioMed Central Ltd.
open-access: This is an Open Access article distributed under the terms of the Creative Commons Attribution License (), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Received Day: 22 Month: 9 Year: 2006
Accepted Day: 7 Month: 11 Year: 2006
collection publication date: Year: 2006
Electronic publication date: Day: 7 Month: 11 Year: 2006
Volume: 1First Page: 41 Last Page: 41
ID: 1654151
Publisher Id: 1749-8090-1-41
PubMed Id: 17090324
DOI: 10.1186/1749-8090-1-41

Left ventricular postoperative false aneurysm following apical venting
Federico Bizzarri1 Email: federico.bizzarri@uniroma1.it
David Rose1 Email: davidrose@libero.it
Giacomo Frati1 Email: fraticello@inwind.it
Luigi Muzzi1 Email: luigimuzzi@hotmail.com
1Dipartimento Cuore e Grossi Vasi " Attilio Reale", Universita' degli Studi di Roma "La Sapienza", Unita' Operativa di Cardiochirurgia. Polo Pontino, Via F.Faggiana 34, Latina, Italy

Case report

Ventricular pseudoaneurysm is a complication of transmural myocardial infarction but may also follow blunt and penetrating chest trauma, inflammatory disease, infective endocarditis, tumours and cardiac surgery [1,2]. The pictures (Fig 1, 2, 3, 4) describe a case of false aneurysm of the left ventricle occurring as a consequence of placing a vent sump line through the apex during an aortic valve procedure. The procedure was accomplished with a mechanical prosthesis and the post operative course was uneventful. Twelve months later the patient underwent a routine echocardiographic evaluation; the four-chamber view revealed the presence of a cavity near the apex connecting to the left ventricle. The echocardiographic and radiologic examination indicated a pseudoaneurysm.

The lesion was successfully treated under cardiopulmonary by-pass and cardioplegic arrest. The mass was completely isolated, opened and identified as a false aneurysm. It appeared as a 5 cm ? 3 cm red sac with free blood inside. The previous site of venting was identified and the cavity connected to the left ventricle (3 mm in diameter) closed with interrupted pledgeted polipropilene sutures. The patient was easily weaned off bypass and was discharged six days later.

Although effective, the apical venting can determine complications such as myocardial injury as well as serious difficulties in closing the vent site.

Because of the severity of the mentioned complication we recommend the use of different routes of left ventricular venting in order to prevent the risk of such complications.


References
Kao CL,Chang JP. Left ventricular pseudoaneurysm secondary to left ventricular apical ventingTex heart inst j 2003;30:162–3. [pmid: 12809265]
Mazzola A,Gregoriani R,et al. Left ventricular pseudoaneurysm secondary to left ventricular venting through the right superior pulmonary veinItal Heart J 2004;5:881–882. [pmid: 15633447]

Figures

[Figure ID: F1]
Figure 1 

The pseudoaneurysm mass as it appeared after isolation from epicardial adherences. The pseudoaneurysm mass as it appeared after isolation from epicardial adherences (Figure 1). After the sac was opened (Figure 2), a leakage in the apical venting site was identified (Figure 3) and repaired with interrupted pledgeted polipropilene sutures (Figure 4).



[Figure ID: F2]
Figure 2 

The pseudoaneurysm mass after the sac was opened. The pseudoaneurysm mass as it appeared after isolation from epicardial adherences (Figure 1). After the sac was opened (Figure 2), a leakage in the apical venting site was identified (Figure 3) and repaired with interrupted pledgeted polipropilene sutures (Figure 4).



[Figure ID: F3]
Figure 3 

A leakage in the apical venting site identified. The pseudoaneurysm mass as it appeared after isolation from epicardial adherences (Figure 1). After the sac was opened (Figure 2), a leakage in the apical venting site was identified (Figure 3) and repaired with interrupted pledgeted polipropilene sutures (Figure 4).



[Figure ID: F4]
Figure 4 

The leakage repaired with interrupted pledgeted polipropilene sutures. The pseudoaneurysm mass as it appeared after isolation from epicardial adherences (Figure 1). After the sac was opened (Figure 2), a leakage in the apical venting site was identified (Figure 3) and repaired with interrupted pledgeted polipropilene sutures (Figure 4).



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