Cases reported "Heart Aneurysm"

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1/246. Pseudoaneurysm of the left ventricle after isolated pericarditis and staphylococcus aureus septicemia.

    Left ventricular pseudoaneurysm after isolated pericarditis as a result of Staphylococcal septicemia is very rare. A case of a very young patient is described. diagnosis is made by echocardiography. Immediate surgical resection of the pseudoaneurysm is the therapy of choice.
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2/246. Intraoperative left ventricular perforation with false aneurysm formation.

    Two cases of perforation of the left ventricle during mitral valve replacement are described. In the first case there was perforation at the site of papillary muscle excision and this was recognized and successfully treated. However, a true ventricular aneurysm developed at the repair site. One month after operation rupture of the left ventricle occurred at a second and separate site on the posterior aspect of the atrioventricular ring. This resulted in a false aneurysm which produced a pansystolic murmur mimicking mitral regurgitation. Both the true and the false aneurysm were successfully repaired. In the second case perforation occurred on the posterior aspect of the atrioventricular ring and was successfully repaired. However, a false ventricular aneurysm developed and ruptured into the left atrium producing severe, but silent, mitral regurgitation. This was recognized and successfully repaired. The implications of these cases are discussed.
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3/246. Three ventriculoplasty techniques applied to three left-ventricular pseudoaneurysms in the same patient.

    A 59-year-old male patient underwent surgery for triple-vessel coronary artery disease and left-ventricular aneurysm in 1994. Four months after coronary artery bypass grafting and classical left-ventricular aneurysmectomy (with Teflon felt strips), a left-ventricular pseudoaneurysm developed due to infection, and this was treated surgically with an autologous glutaraldehyde-treated pericardium patch over which an omental pedicle graft was placed. Two months later, under emergent conditions, re-repair was performed with a diaphragmatic pericardial pedicle graft due to pseudoaneurysm reformation and rupture. A 3rd repair was required in a 3rd episode 8 months later. Sternocostal resection enabled implantation of the left pectoralis major muscle into the ventricular defect. Six months after the last surgical intervention, the patient died of cerebral malignancy. Pseudoaneurysm reformation, however, had not been observed. To our knowledge, our case is the 1st reported in the literature in which there have been 3 or more different operative techniques applied to 3 or more distinct episodes of pseudoaneurysm formation secondary to post-aneurysmectomy infection. We propose that pectoral muscle flaps be strongly considered as a material for re-repair of left-ventricular aneurysms.
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keywords = cerebral
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4/246. Multiple idiopathic left ventricular aneurysms in a Japanese woman.

    Idiopathic aneurysms of the left ventricle (LV) are uncommon in Western society. Multiple idiopathic LV aneurysms are distinctly unusual and are rarely reported. As with aneurysms of atherosclerotic origin, these entities may be associated with chest discomfort, congestive heart failure, cardiac dysrhythmias, and thromboembolic phenomena. We present the case of a Japanese woman living in the united states with chest discomfort, ventricular arrhythmias, and a previous transient ischemic attack who demonstrated four discrete LV aneurysms on ventriculography. Extensive evaluation demonstrated no clear cause for these aneurysms. The patient was treated conservatively with medical therapy and has continued to do well without adverse clinical sequelae.
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5/246. Pseudoaneurysm of the left ventricular free wall caused by tumor infiltration.

    Ventricular pseudoaneurysms occur as complications of myocardial infarction, heart surgery, trauma, and infective endocarditis. The process involves rupture of the ventricular wall where a structural weakness exists and containment of the blood by the pericardium. Although various malignancies may invade the heart, a pseudoaneurysm of the left ventricle caused by tumor has not been reported.
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6/246. 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.
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7/246. Post-traumatic basilar artery thrombosis in a young man with atrial septum aneurysm and prothrombin gene G20210A polymorphism.

    prothrombin gene G20210A polymorphism has been recently identified as a cause of venous thrombosis. However the association between this mutation and arterial thrombosis remains uncertain. Some authors have suggested that the polymorphism in the 3' region of the prothrombin gene may precipitate cerebral arterial thrombosis in young patients with prothrombotic conditions. We report a case of post-traumatic basilar artery thrombosis in a young patient carrier of the prothrombin gene G20210A polymorphism. Thirty-six hours after sustaining a head injury in the occipital region, a young man developed vomiting, headache, dizziness and truncal ataxia, without signs of focal impairment. magnetic resonance imaging and selective angiography carried out 2 days later showed an obstruction of the basilar artery, with infarction of the right cerebellar region. A transthoracic echocardiogram showed a patent foramen ovale with little left-to-right shunt and an aneurysm of the interatrial septum. blood examination showed a heterozygous status for prothrombin gene G20210A polymorphism. We conclude that this prothrombin gene mutation and the coexisting particular head injury and interatrial septal aneurysm could have contributed simultaneously to the development of basilar artery occlusion and cerebellar infarction. We suggest that in selected cases of cerebellar ischemia a prothrombin gene G20210A polymorphism should be considered.
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keywords = foramen, cerebral
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8/246. Pseudoaneurysm of the left ventricular free wall caused by tumor.

    Ventricular pseudoaneurysms occur as complications of myocardial infarction, cardiac operations, trauma, and infective endocarditis. The process involves rupture of the ventricular wall where a structural weakness exists and containment of the blood by the pericardium. Although various malignancies may invade the heart, a pseudoaneurysm of the left ventricle caused by tumor has not been reported.
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9/246. Posterior-septal pseudo-pseudoaneurysm with limited left-to-right shunt: an unexpected easy repair.

    Cardiac rupture represents a fatal complication of acute myocardial infarction within the first two weeks. In exceptional cases, the postinfarction rupture of the myocardium is not transmural but remains circumscribed within the wall itself as a cavity joined to the left ventricle through a narrow neck. This finding is usually defined as pseudo-pseudoaneurysm. We report a rare case of postinfarction posterior pseudo-pseudoaneurysm of the left ventricle, perforated into the right ventricle. This unusual anatomy resulted, over a period of several years, by progressive intramural dissection of the surrounding necrotic myocardium with late formation of a large, partially fibrotic chamber, communicating either with left and right ventricles. Despite correct preoperative diagnosis was not achieved by 2D echocardiography, pulsed Doppler and contrast ventriculography, a successful surgical treatment was possible with a really good outcome.
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10/246. Subvalvular left ventricular aneurysm following mitral valve replacement.

    Two cases are presented which represent different aspects of damage to the posterior wall of the left ventricle following mitral valve replacement. In the first case rupture of the ventricle occurred in the immediate postoperative period with a fatal result, while in the second, delayed aneurysm formation occurred with embolic and haemodynamic complications. This patient also did not survive. A review of the literature reveals four similar cases previously recorded. Possible aetiological factors are considered, including operative trauma, ischaemic damage, rupture of unsupported muscle, previous surgery with the development of pericardial adhesions and fixing of the valve ring, and finally abscess formation. The indications for operative intervention and possible complications of the aneurysm are noted.
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