Vol 29, No 3 (2022)
Image in Cardiovascular Medicine
Published online: 2022-05-31

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Apical left ventricular pseudoaneurysm: Diagnosis by multimodal cardiac imaging

María Anguita-Gámez1, Martín Negreira-Caamaño2, Ivan Nuñez1, Pedro Marcos-Alberca1, María Vidal3, Paula Hernández3, David Vivas1, José A. De Agustín1
Pubmed: 35652142
Cardiol J 2022;29(3):527-528.


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Cardiology Journal 2022, Vol. 29, No. 3, 527–528

DOI: 10.5603/CJ.2022.0042 Copyright © 2022 Via Medica

ISSN 1897–5593 eISSN 1898018X

Apical left ventricular pseudoaneurysm: Diagnosis by multimodal cardiac imaging

María Anguita-Gámez1Martín Negreira-Caamaño2Iván Nuñez1Pedro Marcos-Alberca1María Vidal3Paula Hernández3David Vivas1José A. De Agustín1
1Cardiovascular Institute, San Carlos Clinic Hospital, Madrid, Spain
2Cardiology Department, Universitary General Hospital, Ciudad Real, Spain
3Radiology Department, San Carlos Clinic Hospital, Madrid, Spain

Address for correspondence: Dr. María Anguita-Gámez, Servicio de Cardiología, Hospital Clínico San Carlos, Calle Profesor Martín Lagos, s/n. 28040, Madrid, Spain, tel: 913303000, e-mail: maria.anguita95@gmail.com

Received: 29.09.2021 Accepted: 28.10.2021

This article is available in open access under Creative Common Attribution-Non-Commercial-No Derivatives 4.0 International (CC BY-NC-ND 4.0) license, allowing to download articles and share them with others as long as they credit the authors and the publisher, but without permission to change them in any way or use them commercially.

A 63-year-old woman with a history of permanent atrial fibrillation and mitral valve replacement with a mechanical prosthesis underwent outpatient cardiac catheterization due to repeated atypical chest pain. Coronary angiography showed no coronary stenosis, but ventriculography showed focal dilatation of the ventricular wall at the apical level (Fig. 1, A: Systole, B: Diastole), not described in previous imaging studies. Transthoracic echocardiography showed a short-necked, non-contractile saccular image, located at the apex of the left ventricle (Fig. 1C, D). No wall motion abnormalities were observed. The observed wide neck suggested the diagnosis of aneurysm, but a cardiac magnetic resonance showed a lack of continuity in the muscular layer, and a late gadolinium uptake circumscribed to the adjacent epicardial region (Fig. 1E, F). Thus, a diagnosis of ventricular pseudoaneurysm was established, confirmed by the findings of a cardiac computed tomography (Fig. 1G, H).

Figure 1. Multimodality cardiovascular imaging showing apical left ventricular pseudoaneurysm in the patient; A, B. Contrast invasive ventriculography: left (A) and right (B) anterior oblique views, revealing a small protrusion in the apical segment of myocardial wall. Mitral prosthetic valve was also noticed; C, D. Two-dimensional transthoracic echocardiogram without (C) and with contrast (D) showing the apical protrusion; E, F. Cardiac magnetic resonance: massive left atrial dilatation with a ventricular wall-defect at the apex of the left ventricle (E), and epicardial late gadolinium enhancement (F); G, H. Gated computed cardiac tomography in sagittal view (G) and after three-dimensional reconstruction (H) showing the same findings.

The interest of this case lies on the diffe

rentiation between true ventricular aneurysm and pseudoaneurysm, and about their etiology. Among the causes of pseudoaneurysm, the most frequent is a contained cardiac rupture in acute myocardial infarction.This was ruled out in the present case by the absence of coronary artery disease or myocardial contractility defects. Other more uncommon causes are infective endocarditis, thoracic trauma, congenital diverticula, cardiac surgery (for instance, the use of a transapical dilator for mitral valve commissurotomy) or an embolic myocardial infarction involving the most apical segments of left anterior descendent artery. The latter being a plausible hypothesis in a patient with a mechanical mitral prosthesis.

Conflict of interest: None declared