A Case of Left Ventricular Pseudo-false Aneurysm

Yuki Arakawa＊	Eiji Murakami＊	Kenichiro Azuma＊
Kiyoshi Doi＊＊

（Department of Cardiovascular Surgery, Gifu Municipal Hospital＊, Gifu, Japan, and General and Cardiothoracic Surgery, Graduate School of Medicine, Gifu University＊＊, Gifu, Japan）

A 66-year-old man presented to a local doctor with a chief complaints of episodes of dizziness lasting several seconds. Electrocardiographic findings were suggestive of arrhythmia and old myocardial infarction, and the patient was therefore referred to our hospital. Left ventriculography showed an aneurysm at the posteroinferior wall of the left ventricle, while coronary angiography showed chronic total occlusion of the left circumflex branch（segment 13）and a coronary-pulmonary artery fistula with a coronary aneurysm. On computed tomography, the orifice of the ventricular aneurysm was small, measuring approximately 10 mm. Magnetic resonance imaging showed wall thinning and mural thrombus in the ventricular aneurysm, with aneurysmal dilatation during systole. Suspecting a ventricular false aneurysm resulting from old myocardial infarction, left ventricular reconstructive surgery and resection of the coronary artery aneurysm were performed. Intraoperatively, myocardial necrosis of the posteroinferior wall accompanied by the ventricular aneurysm was seen. There was no pericardial adhesion to the ventricular aneurysm, and the diameter of the orifice of the aneurysm was approximately 10 mm. The ventricular aneurysm was cut open and then closed using a direct suture combined with patch repair. As for the coronary artery aneurysm, the inflow and outflow arteries were each clipped before the wound was closed. The patient had a favorable postoperative course and was discharged from the hospital on the 15th day after surgery. The pathological examination showed residual cardiomyocytes within the aneurysmal wall, thereby establishing the diagnosis of a pseudo-false aneurysm. Our experience with this rare case is reported.

 

Jpn. J. Cardiovasc. Surg. 46:292-295（2017）

Keywords：pseudo-false aneurysm;old myocardial infarction