The contribution of non-invasive imaging modalities to the diagnosis of left ventricular pseudoaneurysm.
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.


OBJECTIVE
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.
Popescu
Bogdan A
BA
Prof. Dr. C. C. Iliescu Institute of Cardiovascular Diseases, Sos. Fundeni 258, sector 2, 72435, Bucharest, Romania. abpope07@cmb.ro
Ginghina
Carmen
C
Coman
Ioan M
IM
Stoian
Ioana
I
Stoica
Adina
A
Stanescu
Dan
D
Georgescu
Serban A L
SA
Fotiade
Bradu
B
Apetrei
Eduard
E
D017541:Aneurysm, False / Q000175:diagnosis* / Q000209:etiology* / Q000601:surgery; D003937:Diagnosis, Differential; D004452:Echocardiography; D004562:Electrocardiography; D005260:Female; D005500:Follow-Up Studies; D006322:Heart Aneurysm / Q000175:diagnosis; D006331:Heart Diseases / Q000150:complications* / Q000175:diagnosis*; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000150:complications; D011379:Prognosis; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D018487:Ventricular Dysfunction, Left / Q000209:etiology