Clinical Physiology of Circulation

ISSN 1814-6910 (Print)
ISSN 2410-9134 (Online)

 

Chief Editor

Leo A. Bockeria, MD, PhD, DSc, Professor, Academician of Russian Academy of Sciences, President of Bakoulev National Medical Research Center for Cardiovascular Surgery


Issue's catalogue ➤ КФК. 2023; 20 (3): 203-320 ➤ Хирургическое лечение псевдоаневризмы левого желудочка у пациентов с осложненными формами ишемической болезни сердца

Surgical treatment of pseudoaneurysms of the left ventricle in patients with complicated forms of coronary artery disease

Authors: Akhmadov I.I., Alshibaya M.D., Mamalyga M.L., Zakargaev R.K., Kalov A.R.

Company:
Bakoulev National Medical Research Center for Cardiovascular Surgery, Moscow, Russian Federation

E-mail: Сведения доступны для зарегистрированных пользователей.

DOI: https://doi.org/10.24022/1814-6910-2023-20-3-207-212

UDC: 616.124.2-007.64+616.12-008.46]-089

Link: Clinical Physiology of Blood Circulaiton. 2023; 3 (20): 207-212

Quote as: Akhmadov I.I., Alshibaya M.D., Mamalyga M.L., Zakargaev R.K., Kalov A.R. Surgical treatment of pseudoaneurysms of the left ventricle in patients with complicated forms of coronary artery disease. Clinical Physiology of Circulation. 2023; 20 (3): 207–12 (in Russ.). DOI: 10.24022/1814-6910-2023-20-3-207-212

Keywords:  heart aneurysm postinfarction left ventricular aneurysm pseudoaneurysm coronary heart disease rupture of the free wall of the left ventricle pseudoaneurysm of the left ventricle acute myocardial infarction

Received / Accepted:  28.07.2023 / 11.09.2023

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Abstract

Despite the continuous improvement of modern methods of prevention and treatment of cardiovascular diseases, this pathology today remains the main cause in the structure of total mortality in many developed countries of the world. Moreover, ischemic heart disease plays a key role among the most common cardiac diseases. The most severe manifestation of coronary heart disease is myocardial infarction. This is one of the main causes of life-threatening complications and mortality in patients with coronary heart disease. In addition, one of the most dangerous complications of acute myocardial infarction (AMI) is associated with rupture of the free wall of the left ventricle and extensive hemorrhage into the pericardium, which leads to instant death, with more than 60% of cases occurring in the prehospital period. A false aneurysm also has characteristic features that distinguish it from both RSLJ and a true left ventricular aneurysm.

Pseudoaneurysm of the left ventricle (PALV) is a very rare but potentially lethal mechanical complication of AMI. According to a number of authors, the incidence of pseudoaneurysms ranges from 0.3–0.5% of all cases of MI. However, in general, MI is burdened with high mortality, often associated with rupture of the false cavity, which leads to catastrophic and often irreversible consequences. Untimely diagnosis and assistance to patients with pseudoaneurysms of the left ventricle are associated with the rare occurrence of this pathology and often the asymptomatic nature of the course of the disease. Timely diagnostic examination is necessary, first of all, for anatomical characteristics of LV rupture and decision-making on surgical access and technique of pseudoaneurysm plasty. This is extremely important to avoid a fatal outcome, since the vast majority of pseudoaneurysms are extremely unstable and often require urgent surgical intervention. Clinically, pseudoaneurysm is manifested by the development of heart failure and arrhythmia, with a significant decrease in the quality of life. The results of surgical treatment of PALV can be considered acceptable, especially given the high mortality associated with the occurrence of a pseudoaneurysm rupture.

Although the resection of a pseudoaneurysm of the left ventricle remains a difficult surgical task, however, in most patients it is possible to achieve acceptable results. Surgical intervention is especially justified in cases where pseudoaneurysms are large or dilated, as they are prone to fatal rupture.

References

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  25. Frances C., Romero A., Grady D. Left ventricular pseudoaneurysm. J. Am. Coll. Cardiol. 1998; 32 (3): 557–61. DOI: 10.1016/s0735-1097(98)00290-3
  26. Komeda M., David T.E. Surgical treatment of postinfarction false aneurysm of the left ventricle. J. Thorac. Cardiovasc. Surg. 1993; 106 (6): 1189–91. PMID: 8246558.
****
  1. Pavlov A.V., Gordeev M.L., Tereshchenko V.I. Types of surgical treatment for postinfarction left ventricular aneurysms. Almanac of Clinical Medicine. 2015; 38: 105–12 (in Russ.). DOI: 10.18786/2072-0505-2015- 38-105-112
  2. Antonic M., Djordjevic A., Mohorko T., Petrovic R., Lipovec R., Juric P. et al. Left ventricular pseudoaneurysm following atrioventricular groove rupture after mitral valve replacement. SAGE Open Med. Case Rep. 2019; 7: 2050313X18823456. DOI: 2050313X18823456
  3. Alapati L., Chitwood W., Cahill J., Mehra S., Movahed A. Left ventricular pseudoaneurysm: A case report and review of the literature. World J. Clin. Cases. 2014; 2 (4): 90–3. DOI: 10.12998/wjcc.v2.i4.90
  4. Frances C., Romero A., Grady D. Left ventricular pseudoaneurysm. J. Am. Coll. Cardiol. 1998; 32 (3): 557–61. DOI: 10.1016/s0735-1097(98)00290-3
  5. Hoey D.R., Kravitz J., Vanderbeek P.B., Kelly J.J. Left ventricular pseudoaneurysm causing myocardial infarction and cerebrovascular accident. J. Emerg. Med. 2005; 28 (4): 431–5. DOI: 10.1016/j.jemermed.2004.12.013
  6. Garcia-Guimaraes M., Velasco-Garcia-de-Sierra C., Estevez-Cid F., Perez-Cebey L., Bouzas-Mosquera A., Mendez-Eirin E. et al. Current role of cardiac imaging to guide surgical correction of a giant left ventricular pseudoaneurysm. Int. J. Cardiol. 2015; 198: 152–3. DOI: 10.1016/j.ijcard.2015.06.129
  7. Bisoyi S., Dash A.K., Nayak D., Sahoo S., Mohapatra R. Left ventricular pseudoaneurysm versus aneurysm a diagnosis dilemma. Ann. Card. Anaesth. 2016; 19 (1): 169–72. DOI: 10.4103/0971-9784.173042
  8. Xu Meng, Yan-Kun Yang, Kun-Qi Yang, Ying Zhang, Pei-Pei Lu, Peng Fan et al. Clinical characteristics and outcomes of left ventricular pseudoaneurysm: A retrospective study in a single-center of China. Medicine (Baltimore). 2017; 96 (18): e6793. DOI: 10.1097/MD.0000000000006793
  9. Smith R., Goldberg H., Bailey C. Pseudoaneurysm of the left ventricle: diagnosis by direct cardioangiography; report of two cases successfully repaired. Surgery. 1957; 42 (3): 496–510. PMID: 13467606
  10. Treistman B., Sulbaran T.A., Cooley D.A. False aneurysm of the left ventricle: case report with pre- and postoperative evaluation. Cardiovasc. Dis. 1978; 5 (2): 144–9. PMID: 15216066; PMCID: PMC287721.
  11. Menicanti L., Di Donato M. The Dor procedure: what has changed after fifteen years of clinical practice? J. Thorac. Cardiovasc. Surg. 2002; 124 (5): 886–90. DOI: 10.1067/mtc.2002.129140
  12. Antunes M.J. Submitral aneurysms of the left ventricle. Correction by new transatrial access. Chief Forensic Med. Expert. 1987; 94: 241–5. DOI: 10.1016/S0022- 5223(19)36287-7
  13. Ono M., Wolf R.K. Pseudoaneurysm of the left ventricle after mitral valve replacement. Ann. Thorac. Surg. 2002; 73: 1303–5. DOI: 10.1016/S0003-4975(01) 03268-4
  14. Prêtre R., Linka A., Jenny R., Turina I. Surgical treatment of acquired pseudoaneurysms of the left ventricle. Ann. Thorac. Surg. 2000; 70: 553–7. DOI: 10.1016/S0003-4975(00)01412-0
  15. Elgarable H., Halbreiner M.S., Schoenhagen P., Navia J.L. Restoration of the pseudoaneurysm of the left ventricle by the triple patch method (Empanada Patch). Interact. Cardiovasc. Thorac. Surg. 2016; 22: 116–7. DOI: 10.1093/icvts/ivv288
  16. Joho S., Asanoi H., Sakabe M., Nakagawa K., Kameyama T., Hirai T. et al. Long-term efficacy of percutaneous intrapericardial fixation therapy with fibrin glue in bleeding type of rupture of the free wall of the left ventricle: a clinical case. Circ. J. 2002; 66: 705–6. DOI: 10.1253/circj.66.705
  17. Clift P., Thorn S., de Giovanni J. Percutaneous closure of the pseudoaneurysm of the left ventricular wall using a device. Heart. 2004; 90: e62. DOI: 10.1136/hrt.2004. 042135 18. Webb J., Gemmell R.M., Al-Faqih K., Chiribiri A. Medical treatment of pseudoaneurysms of the left ventricle. QJM. 2016; 109: 213–4. DOI: 10.1093/qjmed/hcv224
  18. Geron M., Vanderman K.L., Hirsch M., Borman J. Pseudoaneurysm of the left ventricle after myocardial infarction: a curable form of myocardial rupture. J. Thoracic. Cardiovasc. Surg. 1975; 69: 736–42. DOI: 10.1016/S0022-5223(19)41508-0
  19. Al Saidi K., Malik S.A., Albulushi A., Moulton M., Chatzizisis Y.S. Pseudoaneurysm of the left ventricle, complicated by a very late rupture 5 years after myocardial infarction. JACC. 2019; 1: 569–72. DOI: 10.1016/j.jaccas.2019.08.019
  20. Eren E., Bozbuga N., Toker M.E., Keles S., Rabus M.B., Yildirim O. et al. Surgical treatment of postinfarction pseudoaneurysm of the left ventricle: two decades of experience. Tex. Hert Inst. J. 2007; 34 (1): 47–51. PMID: 17420793; PMCID: PMC1847932.
  21. Moreno R., Gordillo E., Zamorano J., Almeria C., Garcia-Rubira J.C., Fernandez-Ortiz A. et al. Longterm results of treatment of patients with postinfarction pseudoaneurysm of the left ventricle. Heart. 2003; 89: 1144–6. DOI: 10.1136/heart.89.10.1144
  22. Narin C., Ege E., Ozkara A., Tanyeli O., Sarkilar G., Soylu A. et al. Surgical treatment of postinfarction pseudoaneurysms of the left ventricle. J. Card. Surg. 2008; 23: 294–8. DOI: 10.1111/j.1540-8191.2007.00544.x
  23. Yoo D., Robertson G., Block P., Babaliaros V., Lattouf O., Pernetz M.A. et al. Percutaneous closure of a left atrial appendage pseudoaneurysm. J. Am. Soc. Echocardiogr. 2011; 24 (1): 109.e1–109.e1093. DOI: 10.1016/j.echo.2010.05.024
  24. Mishra A., Mondal S., Kapoor L., Bharati S. Percutaneous device for closing the “pseudoaneurysm of the left ventricle” after coronary bypass surgery. Representative IHJ Cardiovasc. (CVCR). 2018; 2: 108–10. DOI: 10.1016/j.ihjccr.2018.03.001
  25. Frances C., Romero A., Grady D. Left ventricular pseudoaneurysm. J. Am. Coll. Cardiol. 1998; 32 (3): 557–61. DOI: 10.1016/s0735-1097(98)00290-3
  26. Komeda M., David T.E. Surgical treatment of postinfarction false aneurysm of the left ventricle. J. Thorac. Cardiovasc. Surg. 1993; 106 (6): 1189–91. PMID: 8246558.

About Authors

  • Islam I. Akhmadov, Postgraduate; ORCID
  • Mikhail D. Alshibaya, Dr. Med. Sci., Professor, Head of the Department of Surgical Treatment of Coronary Heart Disease; ORCID
  • Maksim L. Mamalyga, Dr. Med. Sci., Leading Researcher; ORCID
  • Rashid K. Zakargaev, Junior Researcher, Postgraduate; ORCID
  • Astemir R. Kalov, Cand. Med. Sci., Junior Researcher; ORCID

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