Diagnosis of Postinfarction Pseudoaneurysm of the Left Ventricular Free Wall after Coronary Stenting: Case Report

DOI: https://doi.org/10.30702/ujcvs/22.30(04)/LD054-133139
Keywords: postinfarction myocardial rupture, acute myocardial infarction, surgical plastic, mechanical complication of acute myocardial infarction, coronary artery atherosclerosis, left ventricular pseudoaneurysm, coronary heart disease

Abstract

The article is dedicated to topical issues of diagnosis and surgical treatment of postinfarction left ventricular (LV) myocardial rupture. Postinfarction LV rupture is one of the most life-threatening complications of acute myocardial infarction (AMI). Given the low prevalence, this complication almost always leads to a fatal outcome. At the same time, a large proportion of patients (over 60%) die before the diagnosis is verified, suddenly, without specific clinical precursors.

The aim. To draw the attention of doctors to the problem of diagnosis and surgical treatment of LV myocardial rupture as a complication of AMI.

The article describes a clinical case of diagnosis of pseudoaneurysm of the LV free wall after coronary stenting. The peculiarity of this case was absence of a typical pain syndrome, electrocardiographic and echocardiographic signs, suggesting the presenceof such a mechanical complication of AMI. Special attention is paid to the analysis of factors enabling to assess the risk of developing this complication in patients with AMI. The given clinical case demonstrates the importance of early hospitalization and myocardial revascularization by stenting in order to prevent mechanical complications of AMI. Timely diagnosis and urgent surgical treatment of LV myocardial ruptures can reduce mortality due to mechanical complications of AMI.

Conclusions. Timely hospitalization and revascularization of the myocardium in AMI patients reduce the risk of LV rupture in the affected area. The use of echocardiography makesit possible to detect severe complications of AMI with sufficient sensitivity. The only effective treatment method forLV rupture is urgent surgical intervention. Postinfarction myocardial rupture repair is a difficult task considering the initial severity of the patient’s clinical condition, the significant volume and technical complexity of the surgical intervention.

References

  1. Horbas IM. Ishemichna khvoroba sertsia: epidemiolohiia i statystyka [Coronary heart disease: epidemiology and statistics]. Zdorovia Ukrainy. 2009;(3(1)):34-5. Ukrainian.
  2. Bajaj A, Sethi A, Rathor P, Suppogu N, Sethi A. Acute Complications of Myocardial Infarction in the Current Era: Diagnosis and Management. J Investig Med. 2015; 63(7):844-55. https://doi.org/10.1097/JIM.0000000000000232
  3. Hosseinzadeh-Maleki M, Valizadeh N, Rafatpanah N, Moezi SA. Survival after left ventricular free wall rupture due to acute myocardial infarction. ARYA Atheroscler. 2015;11(5):310-3.
  4. Lateef F, Nimbkar N. Ventricular free wall rupture after myocardial infarction. Hong Kong Journal of Emergency Medicine. 2003;10(4):238-46. https://doi.org/10.1177/102490790301000406
  5. López-Sendón J, Gurfinkel EP, Lopez de Sa E, Agnelli G, Gore JM, Steg PG, et al. Factors related to heart rupture in acute coronary syndromes in the Global Registry of Acute Coronary Events. Eur Heart J. 2010;31(12):1449-56. https://doi.org/10.1093/eurheartj/ehq061
  6. French JK, Hellkamp AS, Armstrong PW, Cohen E, Kleiman NS, O’Connor CM, et al. Mechanical Complications After Percutaneous Coronary Intervention in ST-Elevation Myocardial Infarction (from APEX-AMI). Am J Cardiol. 2010;105(1):59-63. https://doi.org/10.1016/j.amjcard.2009.08.653
  7. Srinivas SK, Sunil B, Bhat P, Manjunath CN. Effect of thrombolytic therapy on the patterns of post myocardial infarction ventricular septal rupture. Indian Heart J. 2017;69(5):628-33. https://doi.org/10.1016/j.ihj.2017.03.007
  8. Pineda-De Paz DO, Hernández-Del Rio JE, González-Padilla C, Esturau-Santaló RM, Romero-Palafox J, Grover-Paez F, et al. Left ventricular free-wall rupture, a potentially lethal mechanical complication of acute myocardial infarction: an unusual and illustrative case report. BMC Cardiovasc Disord. 2019;19(1):80.https://doi.org/10.1186/s12872-019-1063-x
  9. Kopytsya NP, Abolmasov AN, Lytvyn EI, Sakal VV. [Mechanical complications of acute myocardial infarction]. Ukrainskyi terapevtychnyi zhurnal. 2013;(1):108-13. Ukrainian.
  10. Varghese S, Ohlow MA. Left ventricular free wall rupture in myocardial infarction: A retrospective analysis from a single tertiary center. JRSM Cardiovasc Dis. 2019;8:2048004019896692. https://doi.org/10.1177/2048004019896692
  11. Prifti E, Bonacchi M, Baboci A, Giunti G, Veshti A, DemirajA, et al. Surgical treatment of post-infarction left ventricular pseudoaneurysm: Case series highlighting various surgical strategies. Ann Med Surg (Lond). 2017;16:44-51. https://doi.org/10.1016/j.amsu.2017.03.013
  12. Abdelnaby M, Al-Maghraby A, Saleh Y, El-Amin A, Abdul Haleem MM, Hammad B. Post-Myocardial Infarction Left Ventricular Free Wall Rupture: A Review. Ann Med Health Sci Res. 2017;7(6):368-72.
  13. Batts KP, Ackermann DM, Edwards WD. Postinfarction rupture of the left ventricular free wall: Clinicopathologic correlatesin 100 consecutive autopsy cases. Hum Pathol. 1990;21(5):530-5. https://doi.org/10.1016/0046-8177(90)90010-3
  14. Serpytis P, Karvelyte N, Serpytis R, Kalinauskas G, Rucinskas K, Samalavicius R, et al. Post-Infarction Ventricular Septal Defect: Risk Factors and Early Outcomes. Hellenic J Cardiol. 2015;56(1):66-71.
  15. Soud M, Moussa Pacha H, Hritani R, Alraies MC. Post myocardial infarction left ventricular pseudoaneurysm. Cardiovasc Revasc Med. 2018;19(2):199-200. https://doi.org/10.1016/j.carrev.2017.08.008
  16. Figueras J, Cortadellas J, Calvo F, Soler-Soler J. Relevance of delayed hospital admission on development of cardiac rupture during acute myocardial infarction: study in 225 patients with free wall, septal or papillary muscle rupture. J Am Coll Cardiol. 1998;32(1):135-9. https://doi.org/10.1016/s0735-1097(98)00180-6
  17. Veremchuk SF, Marunyak SR, Dzyuba DO, Loskutov OA. [Levels of serum C-reactive protein and interleukin-6 as predictors of acute coronary syndrome severity]. Aktualnі problemy suchasnoi medytsyny. 2018;3(63):39-43. Ukrainian.
  18. Honda S, Asaumi Y, Yamane T, Nagai T, Miyagi T, Noguchi T, et al. Trends in the Clinical and Pathological Characteristics of Cardiac Rupture in Patients With Acute Myocardial Infarction Over 35 Years. J Am Heart Assoc. 2014;3(5):e000984. https://doi.org/10.1161/JAHA.114.000984
  19. Flajsig I, Castells y Cuch E, Mayosky AA, Rodriguez R, Calbet JM, Saura E, et al. Surgical Treatment of Left Ventricular Free Wall Rupture after Myocardial Infarction: Case Series. Croat Med J. 2002;43(6):643-8.
  20. Hoffmann U, Shapiro M. Coronary Multidetector Computed Tomography: A New Standard for Preoperative Risk Assessment? J Am Coll Cardiol. 2006;47(10):2025-6. https://doi.org/10.1016/j.jacc.2006.02.031
  21. David TE, Armstrong S. Surgical Repair of Postinfarction Ventricular Septal Defect by Infarct Exclusion. Semin Thorac Cardiovasc Surg. 1998;10(2):105-10. https://doi.org/10.1016/s1043-0679(98)70003-6
  22. Horio N, Teshima H, Ikebuchi M, Irie H. Surgical Outcomes of Left Ventricular Free Wall Rupture and Ventricular Septal Perforation after Acute Myocardial Infarction. Japan J Cardiovasc Surg. 2014;43(6):305-9. https://doi.org/10.4326/jjcvs.43.305
Published
2022-12-26
How to Cite
1.
Lebedieva YO, Denysov SY, Brianskyi MM, Gergi MS, Aliyev RA. Diagnosis of Postinfarction Pseudoaneurysm of the Left Ventricular Free Wall after Coronary Stenting: Case Report. ujcvs [Internet]. 2022Dec.26 [cited 2024Dec.22];30(4):133-9. Available from: https://cvs.org.ua/index.php/ujcvs/article/view/539
Issue
Ukrainian Journal of Cardiovascular Surgery Vol 30 No 4 2022
Section
CASE REPORT