[Pseudoaneurysm and aneurysm of the left ventricle. Discription of a case and long-term follow-up].
Left ventricle pseudoaneurysm is an uncommon complication of myocardial infarction; urgent operation is usually recommended, because of the high rate of severe complications. We report a single case with coexistence of a true aneurysm and a pseudoaneurysm, asymptomatic after three years of follow up in the absence of surgery.


METHODS
The patient, female, aged 69, was observed after an event of prolonged chest pain; ECG showed inferolateral necrosis. Echocardiographic examination showed: left ventricle enlargement with postero-lateral akinesis and septo-apical aneurysm, thin apical thrombosis and mild mitral regurgitation; a non-contractile concameration, aside of lateral wall, containing some thrombotic material and communicating with the left ventricle through a little hole (gap of echoes), crossed by a very little inflow jet. The diagnosis of coexisting septo-apical "true" aneurysm and postero-lateral pseudoaneurysm was confirmed with CT scan, NMR and left ventriculography. Coronary angiography showed total occlusion of LAD and a critical stenosis of mid LAD. The patient refused the operation. In 36 months follow-up no symptoms nor significant echocardiographic changes were observed.


CONCLUSIONS
The pseudoaneurysm is caused by slow fissuration of the myocardium (after a myocardial infarction) with adhesion of pericardium and fibrosis, resulting in a saccular cavity, communicating with the left ventricle by a little hole; on the contrary the more frequent "true" aneurysm is a progressive dilatation and thinning of the ventricular wall, with parietal fibrotic degeneration. Echocardiography may be useful in differential diagnosis, but an excellent quality of the images is required and false negatives and positives are frequent. In this case the echocardiographic features include the thickness of the pseudoaneurysmal wall, the very low flow through the communication hole and the minimal mitralic involvement.


CONCLUSIONS
This particular pattern, when accurately assessed, could probably be predictive of low risk and favorable prognosis in patients with pseudoaneurysm.
Piccone
U
U
Divisione di Cardiologia, Ospedale San Carlo Borromeo, Milano.
Saviotti
M
M
Pala
M
M
Caprari
M
M
D000368:Aged; D017541:Aneurysm, False / Q000473:pathology*; D005260:Female; D005500:Follow-Up Studies; D006322:Heart Aneurysm / Q000473:pathology*; D006352:Heart Ventricles / Q000473:pathology; D006801:Humans