Cardiac CT and MRI guide surgery in impending left ventricular rupture after acute myocardial infarction.
We report the case of a 67 year-old patient who presented with worsening chest pain and shortness of breath, four days post acute myocardial infarction. Contrast enhanced computed tomography of the chest ruled out a pulmonary embolus but revealed an unexpected small subepicardial aneurysm (SEA) in the lateral left ventricular wall which was confirmed on cardiac magnetic resonance imaging. Intraoperative palpation of the left lateral wall was guided by the cardiac MRI and CT findings and confirmed the presence of focally thinned and weakened myocardium, covered by epicardial fat. An aneurysmorrhaphy was subsequently performed in addition to coronary bypass surgery and a mitral valve repair. The patient was discharged home on post operative day eight in good condition and is feeling well 2 years after surgery.
Vogel-Claussen
Jens
J
Russell H, Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD, USA. jclauss1@jhmi.edu
Skrok
Jan
J
Fishman
Elliot K
EK
Lima
João Ac
JA
Shah
Ashish S
AS
Bluemke
David A
DA
D000368:Aged; D005500:Follow-Up Studies; D006322:Heart Aneurysm / Q000175:diagnosis / Q000209:etiology / Q000601:surgery*; D006801:Humans; D053783:Magnetic Resonance Imaging, Interventional; D008297:Male; D009203:Myocardial Infarction / Q000150:complications*; D015641:Radiography, Interventional; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D018658:Ventricular Septal Rupture / Q000175:diagnosis / Q000209:etiology / Q000517:prevention & control*
Am J Med. 1983 Oct;75(4):639-44
6624771
Surg Today. 2008;38(10):951-4
18820874
J Am Soc Echocardiogr. 2000 Oct;13(10):951-2
11029721
Am J Med. 1967 Oct;43(4):639-44
4228813
Circulation. 1975 Mar;51(3):567-72
1132088
Jpn J Thorac Cardiovasc Surg. 2004 Jan;52(1):45-7
14760993
Jpn Circ J. 1999 Jul;63(7):559-63
10462024
Am J Cardiol. 1999 Sep 1;84(5):592-5, A8
10482162
Curr Probl Cardiol. 1993 Jan;18(1):1-79
8425413
Can J Cardiol. 1994 Nov;10(9):927-31
7954029
Prog Cardiovasc Dis. 1979 May-Jun;21(6):461-84
375298
Am J Cardiol. 1994 Jul 15;74(2):184-6
7912882
J Thorac Cardiovasc Surg. 2007 Jul;134(1):237-8
17599518
Circ Cardiovasc Imaging. 2008 Sep;1(2):171-2
19808535
Clin Cardiol. 2007 Jan;30(1):44-7
17262779
Am J Pathol. 1933 Sep;9(5):593-602.3
19970090