Pseudoaneurysm of Left Ventricle

Pseudoaneurysm of left ventricle

Pseudoaneurysm of left ventricle is a contained ventricular rupture with the wall of the pseudoaneurysm composed of pericardium. A true aneurysm has all three layers of the heart – endocardium, myocardium and pericardium and has a relatively wide neck while a pseudoaneurysm has a narrow neck. True aneurysm is usually a thinned and scarred region of the left ventricular myocardium which bulges out in systole, dyskinetic. If it is large it will be visible as a bulge on the left heart border.

Pseudoaneurysm has a high chance of secondary rupture and needs urgent surgical intervention, while true aneurysm is unlikely to do so [1]. Rupture of pseudoaneurysm leads to cardiac tamponade, shock and death if urgent surgical intervention is not feasible. Pseudoaneurysm is usually diagnosed by echocardiography, though it will be seen on other imaging modalities as well.

Samarjit Bisoyi, Anjan K Dash, Debashish Nayak, Satyajit Sahoo and Raghunath Mohapatra reported a case which was thought to be true aneurysm on echocardiography, but turned out to be a pseudoaneurysm intra operatively [1]. Patient had been planned for left ventricular aneurysmoplasty. The aneurysm was excised and the defect in the left ventricular wall closed with pledgeted teflon. He was in New York Heart Association (NYHA) Class I at 3 month follow up.

Reference

1. Samarjit Bisoyi, Anjan K Dash, Debashish Nayak, Satyajit Sahoo, Raghunath Mohapatra. Left Ventricular Pseudoaneurysm Versus Aneurysm a Diagnosis Dilemma. Ann Card Anaesth. Jan-Mar 2016;19(1):169-72.