1/44. Acute left ventricular dysfunction and subarachnoid hemorrhage.OBJECTIVE: Severe left ventricular (LV) dysfunction associated with acute subarachnoid hemorrhage (SAH) due to cerebral aneurysm rupture. SETTING: An adult 12-bed surgical intensive care unit of a university hospital. PATIENT: A female patient presenting with SAH (Hunt & Hess grade III) and severe left ventricular dysfunction. INTERVENTIONS: central venous pressure, arterial blood pressure, extravascular lung water catheter, transesophageal echocardiography, blood gas analysis, electrocardiograms, and chest x-ray for clinical management. MEASUREMENTS AND MAIN RESULTS: On admission to the district hospital, an electrocardiogram (ECG) revealed a sinus rhythm with transient ST elevations. A transesophageal echocardiography showed a left ventricular ejection fraction (LV-EF) of approximately 10%. Severe LV dysfunction required inotropic and vasopressor support to maintain mean arterial pressure above 60 mmHg, while the first measurement of an extravascular lung water catheter revealed a cardiac index of 2.0 L/min/m2 and moderate hypovolemia. Despite stepwise volume loading that increased intrathoracic blood volume--an indicator of cardiac preload--from 719 mL/m2 to 927 mL/m2, cardiac index remained poor. enoximone lead to a marked increase of cardiac index up to 3.9 L/min/m2 and LV-EF to about 30%, but had to be stopped due to thrombopenia. Surgical clipping of an intracranial aneurysm was postponed because of the impaired cardiac function and was performed on day 18 after admission. Interestingly, neurologic outcome was not as poor as might be expected from the literature. CONCLUSION: Severe left ventricular dysfunction may occur in acute SAH and may necessitate delay of aneurysm surgery.- - - - - - - - - - ranking = 1keywords = aneurysm (Clic here for more details about this article) |
2/44. Pseudoaneurysm of the left ventricle progressing from a subepicardial aneurysm.A 56-year-old man presented with an inferior myocardial infarction and a huge pseudoaneurysm below the inferior surface of the left ventricle, which had progressed from a small subepicardial aneurysm over a 6-month period. Transthoracic echocardiography, doppler color flow images, radionuclide angiocardiography, magnetic resonance imaging and contrast ventriculography all revealed an abrupt disruption of the myocardium at the neck of the pseudoaneurysm, where the diameter of the orifice was smaller than the aneurysm itself, and abnormal blood flows from the left ventricle to the cavity through the orifice with an expansion of the cavity in systole and from the cavity to the left ventricle with the deflation of the cavity in diastole. coronary angiography revealed 99% stenosis at the atrioventricular nodal branch of the right coronary artery. At surgery the pericardium was adherent to the aneurysmal wall and a 1.5-cm orifice between the aneurysm and the left ventricle was seen. Pathological examination revealed no myocardial elements in the aneurysmal wall. The orifice was closed and the postoperative course was uneventful. Over-intense physical activity as a construction worker was considered to be the cause of the large pseudoaneurysm developing from the subepicardial aneurysm. These findings indicate that a subepicardial aneurysm may progress to a larger pseudoaneurysm, which has a propensity to rupture, however, it can be surgically repaired.- - - - - - - - - - ranking = 13.14750532553keywords = pseudoaneurysm, aneurysm (Clic here for more details about this article) |
3/44. Concomitant aortic root remodeling and coronary bypass in a patient with poor left ventricular function.A 58-year-old man who had previously undergone rectal cancer surgery and who had poor left ventricular function underwent concomitant aortic root remodeling and coronary bypass for aortic root aneurysm with aortic regurgitation and severe coronary artery disease. Intermittent retrograde cold blood cardioplegia and leukocyte-depleted terminal blood cardioplegia were used for myocardial protection. Angiographic studies 1 month after surgery showed improved left ventricular function at an ejection fraction from 24 to 46%. During a 1-year follow-up, he has remained free of any cardiac event. Even though this report is limited to a case and follow-up, this technique is expected to be beneficial even in patients with severely depressed left ventricular function when the postoperative quality of life is considered.- - - - - - - - - - ranking = 0.33333333333333keywords = aneurysm (Clic here for more details about this article) |
4/44. mitral valve replacement and endocavitary patch repair for a giant left ventricular pseudoaneurysm.We present a case of a giant inferior left ventricular (LV) wall pseudoaneurysm. The patient had new york Heart association class IV heart failure due to severe mitral valve regurgitation and poor LV function. Our operative approach included right thoracotomy, excision of the mitral valve, and patch repair of the pseudoaneurysm neck from inside of the dilated LV cavity followed by mitral valve replacement. Surgery was performed without aortic cross-clamping on a normothermic perfused beating heart. The patient had an uncomplicated cardiac recovery and is doing well 15 months after surgery.- - - - - - - - - - ranking = 12.221257988295keywords = pseudoaneurysm, aneurysm (Clic here for more details about this article) |
5/44. Dor's endoaneurysmorrhaphy in severe heart failure due to giant cell myocarditis.Giant cell myocarditis is an unusual and frequently fatal form of myocarditis. A 37-year-old woman presented with resistant cardiac failure and left ventricular aneurysm. She underwent Dor's endoaneurymorrhaphy and was histopathologically proved to have giant cell myocarditis. She had significant improvement of symptoms and was alive 13 months after surgery. Dor's endoaneurysmorrhaphy may be a useful therapeutic modality in selected cases of giant cell myocarditis.- - - - - - - - - - ranking = 2keywords = aneurysm (Clic here for more details about this article) |
6/44. Successful surgical treatment of ventricular tachycardia that induced left ventricular aneurysm in 12-year-old boy.A surgical treatment of ventricular tachycardia (VT) that induced a congenital left ventricular aneurysm (LVA) in a 12-year-old boy was performed. The VT disappeared after epicardial cryoablation and a reinforcement of LVA with a composite patch. Epicardial cryoablation, based on an intraoperative electrophysiologic study (EPS), is effective in treating VT resistant to antiarrhythmia drugs.- - - - - - - - - - ranking = 1.6666666666667keywords = aneurysm (Clic here for more details about this article) |
7/44. Transmitral endoventricular repair of left ventricular pseudoaneurysm following mitral valve replacement.Left ventricular (LV) pseudoaneurysm is a rare but serious complication of mitral valve replacement and is usually the consequence of atrioventricular separation. Although there may be a role for nonoperative treatment in the presence of a small false aneurysm and in the absence of paravalvular leak, the presence of a large false aneurysm usually mandates surgical intervention. This may be hazardous in patients with concomitant LV dysfunction. We report a case of a patient who presented with a large LV pseudoaneurysm following numerous attempts of mitral valve replacements for a variety of reasons, including endocarditis. Some of the technical details of aneurysm repair and aspects of myocardial protection are discussed. In our patient, avoidance of cardioplegic arrest may have contributed to the successful outcome.- - - - - - - - - - ranking = 13.221257988295keywords = pseudoaneurysm, aneurysm (Clic here for more details about this article) |
8/44. Left ventricular true aneurysm without coronary artery occlusion--a case study.BACKGROUND: Left ventricular true aneurysm is described as distinct area of the left ventricular wall with systolic dyskinesia where typical myocardial structure is replaced with fibrous tissue. Transmural infarction following occlusion of left anterior descending coronary artery is the most common cause of formation of the left ventricular aneurysm. CASE REPORT: A 51-year old white male, with the history of inferolateral wall myocardial infarction 6 years ago was admitted to the emergency department at the local hospital last year because of sudden cardiac arrest due to ventricular fibrillation in the course of inferolateral myocardial infarction. Later on the patient did not come back to work, felt very weak and had dyspnea on mild exertion. Coronary angiogram performed one year later (the patient refused coronary angiography examination at the time of myocardial infarction) showed normal coronary arteries with a recessive right coronary artery. The left coronary artery was wide with normal contrast flow. Ventriculography showed large, true dyskinetic aneurysm with mural thrombus in the apical segment of the left ventricular wall. Left ventricular ejection fraction was 30%. Patient was qualified for the aneurysmectomy. A large dyskinetic aneurysm (8 cm) of the apical and anterolateral segment of the left ventricular wall was detected intraoperatively. A fresh thrombus weighing 9 g was evacuated from the inside of the aneurysm. Stoney's aneurysmectomy was performed. Histopathology showed a typical picture of scar tissue without signs of active inflammation. CONCLUSION: Normal coronary angiogram does not exclude development of large true aneurysm of left ventricular wall of typical localization for acute occlusion of left anterior descendent artery.- - - - - - - - - - ranking = 4keywords = aneurysm (Clic here for more details about this article) |
9/44. Spontaneous coronary artery dissection causing myocardial infarction and left ventricular aneurysm.Spontaneous coronary artery dissection (SCAD) is a rare cause of myocardial infarction (MI). A 66-year-old Japanese man, who had had an anterior wall MI caused by SCAD of the left anterior descending coronary artery, developed left ventricular aneurysm 5 years later, with depressed left ventricular function and thrombus observed on echocardiography. Left endoventricular circular patch plasty according to Dor's technique was performed without coronary artery bypass grafting, because of the absense of significant coronary artery stenosis on the preoperative coronary angiogram. The clinical course of SCAD in the late phase is generally favorable, but because the prognosis of SCAD is uncertain, patients with SCAD should be carefully followed.- - - - - - - - - - ranking = 1.6666666666667keywords = aneurysm (Clic here for more details about this article) |
10/44. Endoventricular circular patch plasty with aortic valve replacement for post-infarction cardiac rupture complicated with aortic valve stenosis: case report.Cardiac rupture after acute myocardial infarction (AMI) in patients with aortic valve stenosis (AS) is uncommon and only 2 survival cases after surgery have been reported to date. The present patient, a 69-year-old woman with aortic valve stenosis (AS), suffered an acute myocardial infarction and despite a successful baloon angioplasty to the proximal left anterior descending artery, the condition progressed into congestive heart failure. Echocardiography demonstrated AS with a valve area of 0.7 cm2 and a left ventricular aneurysm with a thin and dyskinetic anterior to apical wall. An urgent operation was performed and the opening of the pericardium revealed oozing rupture of the aneurysm. An endoventricular circular patch plasty combined with aortic valve replacement was successfully performed, and good results during 2-year follow-up were achieved. Physiological repair with exclusion of the infarcted area is essential to achieve a good long-term outcome in such a critical case. Special care should be taken with AMI in a patient with AS because of the possible occurrence of aneurysm and rupture of the left ventricle.- - - - - - - - - - ranking = 1keywords = aneurysm (Clic here for more details about this article) |
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