Left ventricular posterior wall rupture contained by posterolateral pseudoaneurysm with calcified thrombus


Gültekin N., Özsoy S. D. , Haberal İ.

Türk Kardiyoloji Derneği arşivi, cilt.45, sa.1, ss.104, 2017 (Diğer Kurumların Hakemli Dergileri)

  • Cilt numarası: 45 Konu: 1
  • Basım Tarihi: 2017
  • Dergi Adı: Türk Kardiyoloji Derneği arşivi
  • Sayfa Sayıları: ss.104

Özet

Presently described is case of left ventricular (LV) posterior wall rupture contained

by posterolateral pseudoaneurysm with calcified thrombus. A 63-year-old

male was admitted to coronary intensive care unit with acute pulmonary edema

and required mechanical ventilation for 2 days. He had undergone coronary angiography

with diagnosis of unstable angina 1 year prior, and drug-eluting stent

had been implanted for 90% stenosis of proximal left anterior descending artery

(LAD). Chest radiography revealed enlarged mediastinal and cardiac silhouette.

Computed tomography scan of the chest displayed LV posterior wall rupture contained

by posterolateral pseudoaneurysm with calcified thrombus (Figure A, B,

arrows). Transthoracic echocardiogram showed dilated, hypokinetic LV with inferoposterior

hypokinesia and confirmed pseudoaneurysm 7.1x4.7 cm in size at

widest diameter and with neck length of 4 cm, extending from posterolateral to

anterolateral wall (Figure C and supplementary video 1*). Coronary angiography

revealed double vessel disease with significant stenosis diagonal LAD and total

occlusion in the proximal left circumflex artery (Supplemental video 2 and 3*).

Patient underwent open-heart surgery. Dor technique was used for endo-exclusion

of pseudoaneurysm with endopatch. Rupture was repaired with pericardial patch

and polypropylene running suture. Coronary artery bypass grafting

was performed, and procedure was completed without complications

(Figure D-G and supplementary video 4*). Unfortunately, the next

day, the patient died due to malignant arrhythmia and severe ble