title: Minimally invasive repair of a left ventricular pseudoaneurysm after surgical patch reconstruction of an infarct-related free posterior wall rupture: CT-guided intervention.
abstract: Ventricular free wall rupture remains the most serious complication after acute myocardial infarction. In early-recognized, subacute cases a surgical intervention using patches can be lifesaving. However, in the rare case of postoperative patch leakage, a relapse of a pseudoaneurysm may occur. This is the first case in the literature--to the best of our knowledge--describing a minimally invasive strategy using CT fluoroscopic guidance to perform an injection of thrombin into the perfused pseudoaneurysm to seal a leakage. This therapeutical regimen was chosen--in accordance with cardiac surgeons, cardiologists, and interventional radiologists--due to the high risk of adverse event after repeated surgery in this particular patient. The follow-up images showed complete occlusion of the pseudoaneurysm after the thrombin injection. This approach could be discussed in a multidisciplinary setting in similar cases, especially due to the described negligible recurrence rate after successful initial thrombosis after treating femoral pseudoaneurysms, pseudoaneurysms of the pancreatic artery, or even endoleaks after stenting of aneurysms of the aorta.
authors.affiliation: Department of Clinical Radiology, Ludwig-Maximilians-University, Grosshadern Campus, Marchioninistrasse 15, 81377 Munich, Germany. ralf-thorsten.hoffmann@med.uni-muenchen.de
authors.forename: Ralf Thorsten
authors.initials: RT
authors.lastname: Hoffmann
authors.forename: Konstantin
authors.initials: K
authors.lastname: Nikolaou
authors.forename: Peter
authors.initials: P
authors.lastname: Boekstegers
authors.forename: Bruno
authors.initials: B
authors.lastname: Reichart
authors.forename: Maximilian F
authors.initials: MF
authors.lastname: Reiser
mesh_terms: D000328:Adult; D017541:Aneurysm, False / Q000150:complications / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000209:etiology; D006348:Cardiac Surgical Procedures / Q000009:adverse effects*; D003029:Coagulants / Q000008:administration & dosage*; D005260:Female; D005471:Fluoroscopy; D006322:Heart Aneurysm / Q000150:complications* / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery; D006801:Humans; D015552:Injections, Intralesional; D009203:Myocardial Infarction / Q000150:complications* / Q000000981:diagnostic imaging / Q000601:surgery; D010490:Pericardial Effusion / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery; D015641:Radiography, Interventional / Q000379:methods*; D013917:Thrombin / Q000008:administration & dosage*; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D018658:Ventricular Septal Rupture / Q000150:complications / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery*
chemical_list: D003029:Coagulants; D013917:Thrombin