Pseudoaneurysm with left-to-right shunt in a patient with myocardial infarction: evaluation by three-dimensional echocardiography.
It is often difficult to noninvasively differentiate a post-infarction left ventricular (LV) pseudoaneurysm from a post-infarction true aneurysm. A 66-year-old woman with a past history of inferior acute myocardial infarction was admitted to our hospital because of acute decompensated heart failure. Two-dimensional transthoracic echocardiography showed an aneurysm with a narrow orifice in the inferoposterior basal area. The pulmonary to systemic flow ratio (Q p/Q s) was 2.2:1, which corresponded to moderate left-right shunting. Three-dimensional transesophageal echocardiography (3D-TEE) showed the orifice in the perforated right ventricular basal area with a color jet through the orifice from the LV to the right ventricle. Collectively, based on the 3D-TEE findings, we diagnosed the case as inferoposterior pseudoaneurysm with a left-to-right shunt caused by myocardial infarction.
Division of Cardiovascular Disease, Department of Medicine II, Kansai Medical University, 2-3-1 Shinmachi, Hirakata, Osaka, 573-1191, Japan. maebah@hirakata.kmu.ac.jp.
Hirofumi
H
Maeba
Division of Cardiovascular Disease, Department of Medicine II, Kansai Medical University, 2-3-1 Shinmachi, Hirakata, Osaka, 573-1191, Japan.
Yoko
Y
Miyasaka
Division of Cardiovascular Disease, Department of Medicine II, Kansai Medical University, 2-3-1 Shinmachi, Hirakata, Osaka, 573-1191, Japan.
Ayako
A
Kotaka
Division of Cardiovascular Disease, Department of Medicine II, Kansai Medical University, 2-3-1 Shinmachi, Hirakata, Osaka, 573-1191, Japan.
Satoshi
S
Tsujimoto
Division of Cardiovascular Disease, Department of Medicine II, Kansai Medical University, 2-3-1 Shinmachi, Hirakata, Osaka, 573-1191, Japan.
Fumio
F
Yuasa
Division of Cardiovascular Disease, Department of Medicine II, Kansai Medical University, 2-3-1 Shinmachi, Hirakata, Osaka, 573-1191, Japan.
Toshiji
T
Iwasaka
Left-to-right shunt; Pseudoaneurysm; Three-dimensional transesophageal echocardiography