Left Ventricular Pseudoaneurysm Dissecting into Anterior Chest Wall – A Rare Cause of Sudden Onset Excruciating Chest Pain
KeywordsLeft Ventricular Pseudoaneurysm, Acute Chest Pain, Surgical repair of Left Ventricular Aneurysm, Computerized Tomography in Diagnosis of Left Ventricular Aneurysm.
Left ventricular pseudoaneurysm (LVPA) is associated with a significant mortality rate of up to 45% in the first year after diagnosis. It is a very rare entity and hence the true incidence and natural history are not clearly known. Clinical presentation varies widely and requires a high index of suspicion for diagnosis. We report the case of a 72-year-old woman with a remote history of left ventricular aneurysm repair during coronary bypass surgery who presented to the emergency department with acute onset of left-sided chest pain and a pulsatile chest wall swelling. She was haemodynamically stable but required an intravenous morphine drip for pain control. Contrast-enhanced computed tomography of the chest showed a large LVPA dissecting through the anterior chest wall. Surgical treatment was discussed with the patient but she opted in favour of comfort care. She died 5 days later from complete rupture of the LVPA. With this report, we aim to raise the level of awareness of LVPA that could anatomically expand and rupture. Early diagnosis and timely surgical intervention is the treatment of choice.
Mele D, Pasanisi G, Capasso F, De Simone A, Morales MA, Poggio D, et al. Left intraventricular myocardial deformation dyssynchrony identifies responders to cardiac resynchronization therapy in patients with heart failure. Eur Heart J 2006;27:1070–1078.
Frances C, Romero A, Grady D. Left ventricular pseudoaneurysm. J Am Coll Cardiol 1998;32:557–561.
Eren E, Bozbuga N, Toker ME, Keles C, Rabus MB, Yildirim O, et al. Surgical treatment of post-infarction left ventricular pseudoaneurysm: a two-decade experience. Tex Heart Inst J 2007;34:47–51.
Narayan RL, Vaishnava P, Goldman ME, Stelzer P, Clark L, Kini AS, et al. Percutaneous closure of left ventricular pseudoaneurysm. Ann Thorac Surg 2012;94:e123–125.
Kumar PV, Alli O, Bjarnason H, Hagler DJ, Sundt TM, Rihal CS. Percutaneous therapeutic approaches to closure of cardiac pseudoaneurysms. Catheter Cardiovasc Interv 2012;80:687–699.
García-Lledó A, Moya-Mur JL, de Juan J, García-Pérez-Velasco J, Sanz A, Díaz-Caraballo E. Long-term survival of chronic left ventricular pseudoaneurysm in elderly adults. Is surgery the best option? J Am Geriatr Soc 2014;62:2224–2225.
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