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Resumen Antecedentes: Los pacientes con enfermedad de Chagas pueden desarrollar cardiomiopatía crónica (CChC); los aneurismas ventriculares son característicos de esta condición. Objetivo: Analizar una población de pacientes con CChC con aneurismas ventriculares, buscando asociaciones entre las variables sexo, edad, síntomas, fracción de eyección del ventrículo izquierdo (FEVI), tamaño de los aneurismas y presencia de arritmias ventriculares. Método: Los pacientes fueron valorados con historia clínica, electrocardiografía (ECG), radiología, ecocardiografía y Holter. Resultados: De 627 pacientes con CChC, 60 (9.6%) presentaron aneurismas (60%). Había una relación significativa entre edad mayor de 50 años y FEVI normal. El valor predictivo negativo de clase funcional I y ECG sin anomalías del QRS para detectar FEVI < 50% o taquicardia ventricular fue del 47.4%. No hubo relación significativa entre anomalías del QRS con FEVI < 50% ni taquicardia ventricular. Los aneurismas grandes estaban asociados a FEVI < 50%, pero no fueron predictores de taquicardia ventricular. No hubo asociación significativa entre volúmenes de fin de diástole del ventrículo izquierdo y FEVI o taquicardia ventricular; los pacientes en fase B1-2 no presentaron mayor riesgo de taquicardia ventricular que los de fase C-D. Conclusiones: En los pacientes con CChC se recomienda un estudio integral con ecocardiografía y Holter; el valor predictivo negativo de la clínica y del electrocardiograma es muy reducido.
Abstract Background: Chagas disease patients can develop chronic cardiomyopathy; ventricular aneurysms are characteristic of this condition. Objective: A population of patients with Chagas cardiomyopathy with ventricular aneurysms was analyzed, looking for associations between variables sex, age, symptoms, left ventricular ejection fraction, size of aneurysms and presence of ventricular arrhythmias. Method: The patients were evaluated with a clinical history, electrocardiography, radiology, echocardiography and Holter. Results: Of 627 patients with CChC, 60 (9.6%) had aneurysms, 60%. There was a significant relationship between age older than 50 years and normal LVEF. The negative predictive value of Functional Class I and ECG without QRS abnormalities to detect LVEF < 50% or ventricular tachycardia was 47.4%. There was no significant relationship between QRS abnormalities with LVEF < 50% or ventricular tachycardia. Large aneurysms were associated with LVEF < 50% but were not predictive of ventricular tachycardia. There was no significant association between left ventricular end-diastole volumes and LVEF or ventricular tachycardia; patients in phase B1-2 did not present a greater risk of ventricular tachycardia than those in phase C-D. Conclusions: In patients with CHCC, a comprehensive study with ECO and Holter is recommended, the negative predictive value of the symptoms and the electrocardiogram is very low.
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Resumen: Se informa la conducta anestésica de un caso de pseudoaneurisma ventricular izquierdo crónico secundario a complicación de infarto de miocardio transmural, complicación rara y casi siempre mortal. En este informe se describe el caso de una mujer de 60 años con insuficiencia cardíaca aguda a consecuencia de un infarto cardíaco ocurrido cinco meses atrás, que generó la complicación de la cual damos referencia. El manejo anestésico perioperatorio se logró al enfocarse en mantener una presión arterial estable para garantizar la perfusión cerebral y reducir el riesgo de ruptura completa del aneurisma hacia el espacio mediastinal.
Abstract: The anesthetic behavior of a case of chronic left ventricular pseudoaneurysm secondary to a complication of transmural myocardial infarction, a rare and almost always fatal complication, is reported. This report describes the case of a 60-year-old woman with acute heart failure, this is a consequence of a heart attack that occurred 5 months ago, which generated the complication of which we refer. Perioperative anesthetic management was achieved by focusing on maintaining a stable blood pressure to ensure cerebral perfusion and reduce the risk of complete rupture of the aneurysm into the mediastinal space.
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Left ventricular aneurysm (LVA) is a common complication of myocardial infarction. Traditional medical and surgical treatments are not effective or require high doctors' operational skills and patients' physical fitness. With the development of minimally invasive medical devices, it becomes possible for revivent TC system to treat LVA and reconstruct the left ventricle. This study introduces an existing product and its defect when used. From the perspective of clinical needs, we propose a new design of revivent TC system which realizes accurate force measurement and simplifies surgery.
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Humans , Cardiac Surgical Procedures , Heart Aneurysm , Heart Ventricles , Myocardial InfarctionABSTRACT
Essential thrombocythemia is considered one of the chronic myeloproliferative disorders resulting in arterial thromboembolism, venous thrombosis, and bleeding tendency. We report a case of left ventricular aneurysm with successful treatment of the complications of this disease. A 66-year-old man who suddenly experienced right upper limb paralysis was carried to a nearby hospital. Computed tomography revealed multiple cerebral infarctions. An electrocardiogram confirmed findings of old myocardial infarctions in the anteroseptal wall. Echocardiography indicated a left ventricular aneurysm with mobile thrombus. The blood tests showed an abnormally high platelet count of 120×104/μl. His left ventricular thrombus showed an increasing tendency regardless of heparin administration ; thus, he was transferred to our hospital. The resection of the aneurysm and left ventricular restoration was performed emergently to avoid re-embolism. There was a soft thrombus inside the aneurysm at its apex. During cardiopulmonary bypass, the activated clotting time was not prolonged easily. We gave additional heparin and antithrombin III. The patient had no problem with hemostasis or postoperative bleeding. We started low-molecular-weight heparin from the second postoperative day and he was diagnosed with essential thrombocythemia by bone marrow biopsy. We started warfarin and aspirin on the fifth day after surgery. The number of platelets increased to 183×104/μl on the 8th day ; thus, oral administration of hydroxycarbamide was started. His platelet count fell to less than 100×104/μl around 3 weeks after surgery and he was discharged on the 34th day without new embolisms.
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A 67-year-old man with dyspnea at rest was diagnosed with acute heart failure and admitted to our hospital. Echocardiogram showed severe AR, and CT implied an ascending aortic aneurysm and abnormal space in the aortic root. The patient underwent emergent surgery for suspected acute aortic dissection. Intraoperative findings showed the dehiscence of commissure of the aortic valve, and more, the abnormal space in the aortic root was not due to acute aortic dissection but an aortic subannular left ventricular aneurysm. The aneurysm was sutured and closed, and after that, aortic valve replacement and ascending aortic replacement were performed. Although subannular left ventricular aneurysm is a rare disease, it is important to carry out the preoperative evaluation considering the existence of such diseases.
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Abstract Objective: The study aimed to compare the clinical outcomes of simplified linear plication and classic patch plasty in patients with left ventricular aneurysm (LVA). Methods: We retrospectively reviewed 282 patients undergoing LVA repair between 2006 and 2016. After propensity score matching, 45 pairs of patients receiving LVA surgery were divided into either a patch group (on-pump endoventricular patch plasty) or a plication group (off-pump linear plication). Then, their early surgical outcomes and long-term survival were compared in two matched groups. Results: The heart function improvement at discharge was similar in the two matched groups, while patients in the patch group more commonly suffered from low cardiac output syndrome (P=0.042) with higher proportion of intra-aortic balloon pumping assistance (P=0.034) than patients in the plication group. Compared with patients in the patch group, the patients in the plication group had shorter recovery times, regarding to mechanical ventilation, intensive care unit stay, and hospital stay (P<0.001, P<0.001, and P=0.001, respectively). No significant difference was found in the long-term survival (P=0.62). Conclusions: Off-pump linear plication presented acceptable results in terms of early outcomes and long-term survival. For high-risk patients, the simplified LVA repair technique may be an option.
Subject(s)
Humans , Male , Female , Middle Aged , Aged , Heart Aneurysm/surgery , Heart Aneurysm/mortality , Heart Ventricles/surgery , Reference Values , Time Factors , Survival Analysis , Retrospective Studies , Risk Factors , Follow-Up Studies , Treatment Outcome , Statistics, Nonparametric , Propensity Score , Length of Stay , Medical IllustrationABSTRACT
We report a case of minimally invasive surgery (MICS) for left ventricular aneurysm with a large mobile thrombus, which appeared after chemotherapy for malignant lymphoma. A 42-year-old man with a postinfarction left ventricular aneurysm was admitted to our hospital to receive chemotherapy for malignant lymphoma. Eight days after the first administration of anticancer drugs, echocardiography revealed a large mobile thrombus in the left ventricular aneurysm that was absent on admission. The patient was referred to our department, and left ventricular endoplasty was performed through a small left thoracotomy. He recovered rapidly, and chemotherapy was resumed a month after surgery. This suggests MICS to be a valuable option for left ventricular aneurysm repair.
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A 41-year-old man who had a history of suicide attempt by self-stabbing of the chest at the age of 15 and surgical repair of the stab wound of the heart was transferred to a neurosurgical hospital suffering from right hemiparesis. Stroke was diagnosed and he successfully underwent endovascular thrombectomy but postoperative computed tomography revealed left ventricular aneurysm and intracavitary thrombus that could have caused the embolic stroke. He was transferred to our hospital for cardiac surgery to prevent another embolization. Although an emergency operation had been attempted for the large and mobile thrombus, the patient was carefully observed for 4 weeks prior to surgery because of acute and huge stroke with a high risk of perioperative intracranial hemorrhage. After a fortunately uneventful observation, thrombectomy with left ventriculoplasty was performed successfully and the postoperative course was uneventful without neurological impairment. To prevent a fatal embolic event, postoperative follow-up after successful repair of cardiac injury is mandatory.
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The majority of cardiac left ventricular aneurysms involve the anterior and/or apical wall. We present a case of a 50-year-old man with heart failure caused by a large inferolateral left ventricular aneurysm and associated mitral regurgitation, managed by aneurysmectomy, mitral valvuloplasty, and surgical revascularization.
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Objective To use real-time three-dimensional echocardiography(RT-3DE) to compare the cardiac function related indicators between before operation and at postoperative 2 months in the patients with left ventricular aneurysm(LVA) undergoing emergency percutaneous coronary intervention(PCI),and to assess the PCI short term effect.Methods RT-3DE was applied to observe the left ventricular end-diastolic volume(LVEDV),end systolic volume(LVESV),cardiac output(CO),end-diastolic volume index(EDVI),end systolic volume index (ESVI),cardiac index (CI),left ventricular ejection fraction (LVEF) and left ventricular spherical index(SPI) before operation and at postoperative 2 months in 31 cases of acute anterior myocardial infarction(AAMI) complicating LVA.The patients were divided into the functional LVA group(A),anatomical LVA group (B) and complicating thrombus LVA group(C).The cardiac function parameters in various groups conducted the intra-group and inter group comparisons.Results Compared with before operation,LVEF at postoperative 2 months in the group A was increased and SPI was decreased(P＜0.05);CO,CI and LVEF before operation and at postoperative 2 months in the group B were increased and SPI was decreased(P＜0.05);SPI at postoperative 2 months in the group C was decreased(P＜0.05);EF and SPI before operation and at postoperative 2 months had no statistical difference among 3 groups(P＞0.05).SPI before operation and at postoperative 2 months was negatively correlated with LVEF and positively correlated with EDV,ESV,EDVI,ESVI,CO and CI.Conclusion The left ventricular morphology and overall systolic function at 2 months after PCI in the patients with functional and anatomical LVA are improved,but the curative effect in the patients with complicating thrombus LVA is unobvious.
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Objective To investigate the clinical characteristics,treatment and prognosis of patients with acute myocardial infarction complicated with ventricular septal perforation and ventricular aneurysm formation. Methods The clinical data,treatment methods and prognosis of 11 patients, who admitted between January 2012 and December 2016 in Xinjiang Uygur Autonomous Region People 's Hospital,with acute myocardial infarction complicated with ventricular septal perforation and ventricular aneurysm were analyzed retrospectively. Results the killip grading of the 11 patients were Grade Ⅱ in 1 patients. Grade Ⅱ in 2 patients and Grade Ⅲ in 8 patients .The infarction site was found at the anterior wall in 3 patients,diffuse anterior well in 1 patients,inferior wall in 1 patient, anterior-inferior infarction in 3 patients and diffuse anterior-inferior infarction wall in 1 patient. Septal perforation was found at posterior septum in 5 patients muscular septum in. Patient and at apex in 5 patients. Septal perforation was identified within 24 hours of infarction in 1 patient,within 1-7 days in 3 patients and beyond 7 days after infarction in 7 patients .4 patients with septal perforation chosed conservative medical management only and 2 of them died 1 month later.2 patients had PCI in addition to medical treatment but both of them died in 3 months after discharge. 2 patients had IABP supper,and 1 of then died within 1 week during hospitalzation and the other one died 1 week after discharge. 2 patients received PCI and electric amplatzer closure(4-6 weeks after AMI,and 1 patient received PCI plus elective surgical septal repair and ventricular aneurysm reshaping at 6 months after AMI. All 3 patients survived during follow up. Conclusions For patients with acute myocardial infarction complicated with ventricular septal perforation and ventricular aneurysm formation,aggressive intervention and treatment will improve the clinical prognosis.
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Left ventricular aneurysm (LVA) and false aneurysm are complications of acute myocardial infarction, trauma, and cardiac surgery. Left ventricular false aneurysm (LVFA) is a particularly catastrophic complication owing to its high propensity for rupture. Surgical resection should be considered for LVFA occurring within three months after myocardial infarction or development of congestive heart failure. In this report, we describe a case of acute heart failure with LVA and LVFA occurring in stage as a complication of myocardial infarction in a 55-year-old man. The patient was also at risk of brain ischemia due to abnormal vessel status and a previous cerebrovascular accident with left-sided weakness. Successful perioperative anesthetic management was achieved by focusing on maintaining marginal upper normal blood pressure to ensure cerebral perfusion and to reduce the risk of false aneurysm rupture.
Subject(s)
Humans , Middle Aged , Aneurysm , Aneurysm, False , Blood Pressure , Brain Ischemia , Heart Failure , Myocardial Infarction , Perfusion , Rupture , Stroke , Thoracic SurgeryABSTRACT
Objective To explore the correlation between matrix metalloproteinase‐9(MMP‐9) and cardiac function ,aneu‐rysm volume in the process of left ventricular aneurysm (LVA) formation .Methods Rabbit models of LVA were established in 20 New Zealand rabbits by lighting left anterior descending artery and left circumflex artery .Two‐dimensional echocardiography were performed at preoperative and postoperative 1 d ,2 d ,3 d ,1 w ,2 w ,3 w ,4 w .The survived animals which had LVA formed were en‐rolled .Real time three‐dimensional echocardiography was performed to obtain left ventricular volume ,LVEF and LVA volume ,The MMP‐9 serum concentration was measured by ELISA .Results (1)There were a significant increase in the serum concentration of MMP‐9 from postoperative 1 d and arrived at the peak at postoperative 3 d ,there were higher than preoperative at postoperative 4 w (P<0 .05) .(2)Compared with preoperative ,the LVEDV ,LVESV and LVAV volume at postoperative showed an increase trend (P<0 .05) ,while there was a decreasing trend in LVEF(P<0 .05) .(3)The MMP‐9 had the better relationship with LVEF at post‐operative 1 d ,2 d ,3 d ,1 w ,2 w ,3 w ,4 w ,in which MMP‐9 had the tightest relationship with LVEF at postoperative 3 d (r=0 .731 , P<0 .05) .MMP‐9 had the better relationship with LVA volume at postoperative 2 d ,3 d ,1 w ,2 w ,3 w ,4 w ,in which MMP‐9 had the tightest relationship with LVA volume at postoperative 3 d (r=0 .636 ,P<0 .05) .Conclusion The MMP‐9 had an effect on cardiac function and LVA volume in the process of LVA formation .
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Objective To determine the renal function compromised in patients after ST-segment elevation myocardial infarction (STEMI) with left ventricular aneurysms (LVA) by measurement of serum cystatin C (Cy-C) concentrations and Cy-C-based eGFR.Methods A total of 355 patients admitted from January 2011 to December 2012 could be categorized into group A (STEMI without LVA,n =183) and group B (STEMI with LVA,n =172) confirmed by echocardiography in 24 hour after admission.Of them,273 patients were treated with primary percutaneous coronary intervention (PCI) after admission and included in the analysis.Cy-C-based estimated glomerular filtration rate (eGFR) and creatinine (Cr)-based eGFR were calculated for evaluating cardiac function in tern to assess the magnitude of compromised renal function.The correlation between magnitude of compromised renal function and in-hospital mortality was analyzed.Distributions of categorical variables were compared using the chi-square test.Continuous variables were compared by one-way ANOVA with the Bonferroni test.Results The in-hospital mortality rate of whole patient cohort was 14.0％.Mortality in the group B was 18.6％ and in the group A was 9.8％ (P ＜ 0.01).With multivariable regression analysis,the compromised renal function was found when the Cr-based eGFR was ＜60 mL/ (min · 1.73 m2) or Cy-C-based eGFR was ＜ 60 mL/min/1.73m2 which were independently associated with in-hospital mortality (OR 0.13,95％ CI 0.02-0.7,P =0.02 ; OR 0.01,95％CI 0.003-0.05,P ＜ 0.01).Compared with the acute myocardium infarction (AMI) patients with chronic kidney disease (CKD) stage 2,the Cy-C based eGFR was greater in the AMI patients with LVA group (P ＜ 0.05),and compared with AMI with CKD stages 3 or CKD 3-5,this difference was also significant (P ＜ 0.01).Conclusions Renal dysfunction was an independent predictor of in-hospital mortality in patients with STEMI,especially in patients with LVA.Cy-C and Cy-C based eGFR were more sensitive to judge renal dysfunction in STEMI patients with LVA.
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Objectives To establish a cost-effective and reproducible procedure for induction of chronic left ventricular aneurysm (LVA) in rabbits. Methods Acute myocardial infarction (AMI) was induced in 35 rabbits via concomitant ligation of the left anterior descending (LAD) coronary artery and the circumflex (Cx) branch at the middle portion. Development of AMI was co n-firmed by ST segment elevation and akinesis of the occluded area. Echocardiography, pathological evaluation, and agar i n-tra-chamber casting were utilized to validate the formation of LVA four weeks after the surgery. Left ventricular end systolic pressure (LVESP) and diastolic pressure (LVEDP) were measured before, immediately after and four weeks after ligation. D i-mensions of the ventricular chamber, thickness of the interventricular septum (IVS) and the left ventricular posterior wall (LVPW) left ventricular end diastolic volume (LVEDV) and systolic volume (LVESV), and ejection fraction (EF) were recorded by echo-cardiography. Results Thirty one (88.6%) rabbits survived myocardial infarction and 26 of them developed aneurysm (83.9%). The mean area of aneurysm was 33.4% ± 2.4% of the left ventricle. LVEF markedly decreased after LVA formation, whereas LVEDV, LVESV and the thickness of IVS as well as the dimension of ventricular chamber from apex to mitral valve annulus significantly increased. LVESP immediately dropped after ligation and recovered to a small extent after LVA formation. LVEDP progressively increased after ligation till LVA formation. Areas in the left ventricle (LV) that underwent fibrosis included the apex, anterior wall and lateral wall but not IVS. Agar intra-chamber cast showed that the bulging of LV wall was prominent in the area of aneurysm. Conclusions Ligation of LAD and Cx at the middle portion could induce develo pment of LVA at a mean area ratio of 33.4%±2.4%which involves the apex, anterior wall and lateral wall of the LV.
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Isolated left ventricular noncompaction (LVNC) is a rare disorder caused by embryonic arrest of compaction. LVNC is sometimes associated with other congenital cardiac disorders; however, there have been few reports of its coexistence with a left ventricular aneurysm. A 40-year-old woman was admitted to our hospital for renal infarction. She had a history of embolic cerebral infarction 10 years ago. Transthoracic echocardiography showed prominent trabeculae and deep intertrabecular recesses which are filled with blood from the left ventricular (LV) cavity. A thrombus in the akinetic apical wall was confirmed by contrast echocardiography. Using cardiac computed tomography and magnetic resonance imaging, we rejected a possible diagnosis of suspicion of coronary artery disease. She was diagnosed LVNC with a thrombus in apical aneurysm. Here, we report the first patient in Korea known to have LVNC accompanying LV congenital aneurysm presenting with recurrent embolism.
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Adult , Female , Humans , Aneurysm , Cerebral Infarction , Coronary Artery Disease , Echocardiography , Embolism , Infarction , Korea , Magnetic Resonance Imaging , ThrombosisABSTRACT
We present a rare case of a 59-year-old-man with a diagnosis of hypertrophic cardiomyopathy (HCM) complicated with left ventricular thrombus. He was admitted to our hospital because of acute re-occlusion of the right brachial artery. Thrombectomy was performed and reperfusion was obtained. Anti-coagulation therapy was started from that day. Four days after surgery, echocardiography revealed mobile thrombus in left ventricular apical aneurysm that was not detected on admission. An emergency thrombectomy and left ventriculoplasty was performed. The patient was discharged 22 days after surgery in good condition.
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Congenital left ventricular aneurysm is a rare, poorly understood and potentially lethal congenital heart disease. Few pediatric cases have been reported. This aneurysm is defined as a fibrous outpouch with paradoxical contractility and appears to be a developmental anomaly, an idiopathic dysplasia of left ventricular endocardium and myocardium. We report a case of congenital left ventricular aneurysm presenting an abnormal electrocardiography in a 65-year old woman without cardiac symptoms. Congenital left ventricular aneurysm was diagnosed by echocardiography and left ventriculogram.
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Aged , Female , Humans , Aneurysm , Echocardiography , Electrocardiography , Endocardium , Heart Defects, Congenital , MyocardiumABSTRACT
Left ventricular(LV) aneurysm is one of common complications of acute myocardial infarction. Inferior location of LV aneurysm is relatively rare, but it often compromises posterior papillary muscle function and causes early death due to severe mitral regurgitation. Survival of patients with inferior LV aneurysm depends, to a great extent, on the extent of the involvement of mitral valve apparetus. We describe three cases of 'giant' inferior LV aneurysm, which were observed in patients with myocardial infarction.