Palavras-chave
Traumatismo torácico
Cirurgia cardíaca
Reconstrução ventricular
Técnica de Empanada
Como Citar
Resumo
O pseudoaneurisma do ventrículo esquerdo (PSA-VE) representa uma complicação mecânica rara e letal, caracterizada pela ruptura contida da parede livre ventricular. Embora predominantemente associado ao infarto agudo do miocárdio, o PSA-VE pós-traumatismo torácico constitui uma entidade clínica distinta, desafiadora pelo diagnóstico tardio e pela complexidade anatômica. A recorrência desta patologia após o reparo cirúrgico inicial é um evento catastrófico, associado a taxas de mortalidade elevadas, exigindo estratégias de reconstrução avançadas que vão além da sutura simples. Esta revisão sistemática examina a fisiopatologia da recorrência em cenários traumáticos, as modalidades diagnósticas multimodais e detalha as técnicas cirúrgicas contemporâneas, incluindo a técnica de sanduíche com Teflon, a técnica de "Empanada" (patch triplo), a reconstrução endoventricular (procedimento de Dor) e as abordagens percutâneas emergentes. A análise crítica da literatura sugere que a durabilidade do reparo secundário depende fundamentalmente do alívio da tensão parietal e da preservação da geometria ventricular.
Referências
ACHARYA, D.; NAGARAJ, H.; MISRA, V. K. Transcatheter closure of left ventricular pseudoaneurysm. Journal of Invasive Cardiology, v. 24, n. 6, p. E111-114, 2012.
AL-HALEES, Z. et al. Traumatic left ventricular pseudoaneurysm: rare presentation and successful surgical repair. Journal of Cardiothoracic Surgery, v. 19, n. 1, p. 45, 2024.
ATIK, F. A. et al. Surgical treatment of postinfarction left ventricular pseudoaneurysm. The Annals of Thoracic Surgery, v. 82, n. 6, p. 2393-2399, 2006.
BHARDWAJ, R. et al. Left ventricular pseudoaneurysms: a contemporary surgical management and outcomes—our 15-year experience. Healthcare Bulletin, 2023. Disponível em: https://www.healthcare-bulletin.co.uk. Acesso em: 28 nov. 2025.
DAVID, T. E. et al. Postinfarction ventricular septal rupture: the value of obliteration of the infarct. The Journal of Thoracic and Cardiovascular Surgery, v. 146, n. 2, p. 283-290, 2013.
DIAS, L. M.; LEITÃO, V. R. Recorrência de Pseudoaneurisma de Ventrículo Esquerdo Pós-Traumatismo Torácico: Relato de Caso. Journal of Advanced Clinical Implementation and Applied Medical Innovations, v. 2, n. 1, p. 30-49, 2025. DOI: 10.5281/zenodo.15399587.
DUDIY, Y. et al. Percutaneous closure of left ventricular pseudoaneurysm. Circulation: Cardiovascular Interventions, v. 4, n. 4, p. 322-326, 2011. DOI: 10.1161/CIRCINTERVENTIONS.111.962464.
ELGHARABLY, H. et al. Repair of left ventricular pseudoaneurysm with the triple patch technique ('Empanada Patch'). Interactive CardioVascular and Thoracic Surgery, v. 22, n. 1, p. 116-118, 2016. DOI: 10.1093/icvts/ivv288.
FRANCES, C. et al. Left ventricular pseudoaneurysm. Journal of the American College of Cardiology, v. 32, n. 3, p. 557-561, 1998.
GARG, V.; ARORA, D.; MISHRA, M. Left Ventricle Pseudoaneurysm-Recurrence following Surgical Repair. Annals of Cardiac Anaesthesia, v. 24, n. 4, p. 473-475, 2021. DOI: 10.4103/aca.ACA_195_20.
KOMEDA, M.; DAVID, T. E. Surgical treatment of postinfarction false aneurysm of the left ventricle. The Journal of Thoracic and Cardiovascular Surgery, v. 106, n. 6, p. 1189-1191, 1993.
KUMAR, S. et al. Percutaneous closure of left ventricular pseudoaneurysm using Amplatzer septal occluder. Journal of Cardiology Cases, v. 19, n. 3, p. 95-98, 2019.
LOZANO, I. et al. Traumatic left ventricular pseudoaneurysm: diagnosis and therapeutic options. Revista Española de Cardiología, v. 66, n. 7, p. 592-594, 2013.
MAGNAN, A. et al. Percutaneous Closure of Left Ventricular Pseudoaneurysm After Surgical Patch Dehiscence. JACC: Case Reports, v. 15, p. 101859, 2023. DOI: 10.1016/j.jaccas.2023.101859.
MALAGÓN, P. et al. Saphenous vein graft pseudoaneurysm in an 85-year-old man after recent reoperation coronary artery bypass surgery. Circulation, v. 124, n. 18, p. e474-e476, 2011. DOI: 10.1161/circulationaha.111.043984.
MALAKI, M. et al. Infected left ventricular pseudoaneurysm: a case report. Heart Surgery Forum, v. 9, n. 6, p. E876-879, 2006.
MENG, X. et al. Surgical treatment of postinfarction left ventricular pseudoaneurysm. The Annals of Thoracic Surgery, v. 96, n. 1, p. 103-108, 2013.
MORENO, R. et al. Long term outcome of patients with postinfarction left ventricular pseudoaneurysm. Heart, v. 89, n. 10, p. 1144-1146, 2003.
PRETRE, R. et al. Surgical treatment of acquired left ventricular pseudoaneurysms. The Annals of Thoracic Surgery, v. 70, n. 2, p. 553-557, 2000.
SARTIPY, U. et al. Left ventricular reconstruction with the Dor procedure. The Annals of Thoracic Surgery, v. 80, n. 4, p. 1269-1276, 2005.
SHIMAHARA, Y. et al. Sandwich patch repair with a gluing technique for postinfarction ventricular septal defect. Journal of Cardiac Surgery, v. 35, n. 7, p. 1656-1659, 2020.
UMER, M. et al. Multiple recurrences of a left ventricular pseudoaneurysm: a case report. European Heart Journal - Case Reports, v. 8, n. 8, p. ytae382, 2024. DOI: 10.1093/ehjcr/ytae382.
VUKOVIC, P. et al. Surgical treatment of a left ventricular pseudoaneurysm with an extracellular matrix patch. Journal of Cardiothoracic Surgery, v. 18, n. 1, p. 122, 2023. DOI: 10.1186/s13019-023-02265-5.
YANG, X. et al. Recurrence of traumatic left ventricular pseudoaneurysm case series. BMC Cardiovascular Disorders, v. 24, p. 115, 2024. DOI: 10.1186/s12872-024-03750-w.
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