Document Detail

The contribution of non-invasive imaging modalities to the diagnosis of left ventricular pseudoaneurysm.
MedLine Citation:
PMID:  12638339     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: Left ventricular pseudoaneurysm (LVPA) is a rare entity characterized by a tendency to spontaneous rupture due to its morphology, a lack of myocardial fibers and fibrous tissue delineating the cavity. An early diagnosis is essential in order to guide appropriate therapy. PURPOSE: To determine the diagnostic accuracy of different imaging techniques, treatment results, and prognosis of patients (pts) with LVPA. METHODS: We evaluated the incidence of LVPA during a five-year period. The initial clinical presentation, the etiology of LVPA, time between symptom onset and diagnosis, and use of various non-invasive techniques were studied. Mean follow-up was 15 months. RESULTS: Of 19113 pts admitted to our Institute in a five-year period, LVPA was diagnosed in 11 pts (0.05%) (mean age 51 +/- 3.9 years, 8 men). The diagnosis of LVPA was confirmed by surgery in 4 pts, and by pathology in 2 pts. LVPA was an incidental finding in one asymptomatic pt, it was diagnosed in 6 pts presenting with an acute myocardial infarction (AMI) and in 4 pts presenting with LV failure. The main etiology was coronary artery disease (CAD) (9 pts), with the remaining 2 cases being post-traumatic (thoracic stab wound, surgery). LVPA location was postero-inferior in 6 patients, infero-lateral in 3 patients, and anterior in 2 patients. ECG, X-ray and TTE were performed in all cases. 6 pts had a radionuclide angiography (RNA), 3 pts had a computed tomography (CT) scan and 2 pts had a magnetic resonance imaging (MRI) study. Two-dimensional transthoracic echocardiography (TTE) provided information regarding LVPA dimensions and LV-LVPA flow. Four pts were operated (one died). Of the seven non-operated pts., 5 died. CONCLUSIONS: The clinical presentation was variable and non-specific. The most frequent cause of LVPA was MI and the most frequent location was inferior. Echocardiography offered the most reliable information when compared to ventriculography. Because clinical examination, ECG, X-ray data are non-specific for the diagnosis of LVPA, an adequate TTE study performed with a high clinical index of suspicion (especially in pts with inferior MI or thoracic trauma) could facilitate the early diagnosis of LVPA and could be relevant to outcome.
Bogdan A Popescu; Carmen Ginghina; Ioan M Coman; Ioana Stoian; Adina Stoica; Dan Stanescu; Serban A L Georgescu; Bradu Fotiade; Eduard Apetrei
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Przegla̧d lekarski     Volume:  59     ISSN:  0033-2240     ISO Abbreviation:  Prz. Lek.     Publication Date:  2002  
Date Detail:
Created Date:  2003-03-17     Completed Date:  2003-05-29     Revised Date:  2004-11-17    
Medline Journal Info:
Nlm Unique ID:  19840720R     Medline TA:  Przegl Lek     Country:  Poland    
Other Details:
Languages:  eng     Pagination:  642-5     Citation Subset:  IM    
Prof. Dr. C. C. Iliescu Institute of Cardiovascular Diseases, Sos. Fundeni 258, sector 2, 72435, Bucharest, Romania.
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MeSH Terms
Aneurysm, False / diagnosis*,  etiology*,  surgery
Diagnosis, Differential
Follow-Up Studies
Heart Aneurysm / diagnosis
Heart Diseases / complications*,  diagnosis*
Magnetic Resonance Imaging
Middle Aged
Myocardial Infarction / complications
Tomography, X-Ray Computed
Treatment Outcome
Ventricular Dysfunction, Left / etiology

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