Keywords
Lesões Torácicas
Ecocardiografia Transtorácica
Procedimentos Cirúrgicos Cardíacos
How to Cite
Abstract
Objective: To report a recurrent left ventricular (LV) pseudoaneurysm in a 19-year-old patient after blunt chest trauma and prior surgical repair, and to compare findings with current literature. Methods: A case report detailing clinical presentation, transthoracic echocardiography (TTE), and left ventriculography, accompanied by a targeted literature review on LV pseudoaneurysm etiology, imaging diagnostics, and management strategies. Results: The patient experienced focal chest pain and progressive dyspnea. TTE revealed an 8.4 × 7.7 cm sac with a 19 mm neck and “to-and-fro” flow. Ventriculography showed diffuse hypokinesia and a large defect. Early surgical repair using bovine pericardium was performed without immediate complications. Recurrence after trauma is exceptional (< 10% of cases). Early intervention in symptomatic or large (> 3 cm) pseudoaneurysms is critical to mitigate rupture risk, which can reach 45% within three months. Conclusion: This rare recurrence underscores the importance of prolonged follow-up and individualized management. Combined use of TTE and ventriculography guided timely surgical intervention, demonstrating the efficacy of open repair with pericardial reinforcement in late presentations.
References
AGUIAR, J.; BARBA, M.M.; ALBA, J.; CAETANO, J.; FERREIRA, A.; NOBRE, A.; CRAVINO, J. Aneurisma do ventrículo esquerdo e diagnóstico diferencial com pseudoaneurisma. Revista Portuguesa de Cardiologia, v. 31, p. 459–462, 2012. Disponível em: https://doi.org/10.1016/j.repc.2012.04.001.
BADUI, E. et al. False aneurysm of the left ventricle due to a penetrating chest wound. Chest, v. 100, n. 5, p. 1473–1474, 1991. Disponível em: https://doi.org/10.1378/chest.100.5.1473.
BALLARD, D.H.; JOKERST, C.; RAPTIS, C.A.; PILGRAM, T.K.; WOODARD, P.K. The myocardial cut-off sign is a sensitive and specific cardiac computed tomography and magnetic resonance imaging sign to distinguish left ventricular pseudoaneurysms from true aneurysms. Journal of Thoracic Imaging, v. 37, n. 1, p. 58–65, 2022. Disponível em: https://doi.org/10.1097/RTI.0000000000000525.
BANISAUSKAITE, A.; VELAVAN, P.; HASTLETON, J.; MEDIRATTA, N.; ARZANAUSKAITE, M.; BINUKRISHNAN, S. Myocardial rupture and left ventricular pseudoaneurysm due to late STEMI presentation during the COVID-19 pandemic lockdown: a classical case report. European Heart Journal - Case Reports, v. 5, n. 7, ytab253, 2021. Disponível em: https://doi.org/10.1093/ehjcr/ytab253.
BLAŻEJEWSKI, J.; SINKIEWICZ, W.; BUJAK, R.; BANACH, J.; KARASEK, D.; BALAK, W. Giant post-infarction pseudoaneurysm of the left ventricle manifesting as severe heart failure. Kardiologia Polska, v. 70, n. 1, p. 85–87, 2012.
CHEN, F. et al. Post-traumatic left ventricular outflow tract pseudoaneurysm. The Annals of Thoracic Surgery, v. 97, n. 1, p. 311–312, 2014. Disponível em: https://doi.org/10.1016/j.athoracsur.2013.04.137.
CURRIE, A. et al. Delayed presentation of a post-traumatic left ventricular pseudoaneurysm in a child. The Annals of Thoracic Surgery, v. 89, n. 5, p. 1633–1635, 2010. Disponível em: https://doi.org/10.1016/j.athoracsur.2009.10.011.
FALCÃO, J.L.A.A.; FALCÃO, S.N.R.S.; GARCIA, M.F.M.A.; ARRUDA, A.L.M.; HUEB, A.C.; JATENE, F.B.; GUTIERREZ, P.S.; NICOLAU, J.C.; RAMIRES, J.A.F.; GIRALDEZ, R.R.C.V. Pseudoaneurisma ventricular esquerdo associado a insuficiência mitral grave complicando infarto agudo do miocárdio inferolaterodorsal. Arquivos Brasileiros de Cardiologia, v. 84, n. 6, p. 488–491, 2005. Disponível em: https://doi.org/10.1590/S0066-782X2005000600011.
FIALHO, G.L.; FISCHER, C.H.; CORDOVIL, A.; CAMPOS FILHO, O. Pseudoaneurisma crônico do ventrículo esquerdo de etiologia indeterminada. Arquivos Brasileiros de Cardiologia, v. 94, n. 1, p. e4–e6, 2010. Disponível em: https://doi.org/10.1590/S0066-782X2010000100024.
FRANCES, C.; ROMERO, A.; GRADY, D. Left ventricular pseudoaneurysm. Journal of the American College of Cardiology, v. 32, n. 3, p. 557–561, 1998. Disponível em: https://doi.org/10.1016/S0735-1097(98)00290-3.
GAFFRÉE, O.; WENDER, O.; SAADI, J.; FERREIRA, R.; MALUF, F.; ROBERTO, N. Pseudoaneurisma ventricular esquerdo: relato de um caso e revisão da literatura. Arquivos Brasileiros de Cardiologia, v. 48, p. 245–248, 1987.
GOMES, Maurício de Castro et al. Pseudo-aneurisma de ventrículo esquerdo por rotura cardíaca após infarto agudo do miocárdio: tratamento cirúrgico. Revista Brasileira de Cirurgia Cardiovascular, São José do Rio Preto, v. 12, n. 2, p. 141-144, abr. 1997.
HOLTACKERS, R.J.; TER BEKKE, R.M.A.; BIJVOET, G.P.; GOMMERS, S.; CHIRIBIRI, A.; LORUSSO, R. A Boolean dilemma: true or false aneurysm? JACC: Case Reports, v. 3, n. 1, p. 112–116, 2020. Disponível em: https://doi.org/10.1016/j.jaccas.2020.09.055.
IALHO, Guilherme Loureiro et al. Pseudoaneurisma crônico do ventrículo esquerdo de etiologia indeterminada. Arquivos Brasileiros de Cardiologia, São Paulo, v. 94, n. 1, p. 1-4, jan. 2010.
IKEDA, N. et al. Left ventricular pseudoaneurysm following surgical repair of ventricular septal defect in an infant. Pediatric Cardiology, v. 40, n. 5, p. 1097–1100, 2019. Disponível em: https://doi.org/10.1007/s00246-019-02119-x.
JACOB, J.L.B.; BUZELLI, G.; MACHADO, N.C.S.; GARZON, P.G.A.; GARZON, S.A.C. Pseudoaneurysm of left ventricle. Arquivos Brasileiros de Cardiologia, v. 89, n. 1, p. e1–e2, 2007. Disponível em: https://doi.org/10.1590/S0066-782X2007001300012.
JULIANA, A. E. et al. Infectious pseudo-aneurysm of the left ventricle: a case report and a review of the literature. BMC Cardiovascular Disorders, v. 20, n. 1, p. 28, 2020. Disponível em: https://doi.org/10.1186/s12872-019-01299-x.
KOMEDA, M.; DAVID, T.E. Surgical treatment of postinfarction false aneurysm of the left ventricle. The Journal of Thoracic and Cardiovascular Surgery, v. 106, p. 1189–1191, 1993.
LI, X. et al. The evolution of left ventricular pseudoaneurysm from the rupture of left ventricular free wall following acute myocardial infarction: a case report. BMC Cardiovascular Disorders, v. 20, n. 1, p. 5, 2020. Disponível em: https://doi.org/10.1186/s12872-019-01321-2.
MARCOS-GÓMEZ, G.; MERCHÁN-HERRERA, A.; GÓMEZ-BARRADO, J.J.; DE LA CONCEPCIÓN-PALOMINO, F.; VEGA-FERNÁNDEZ, J.; LÓPEZ-MÍNGUEZ, J.R. Pseudoaneurisma ventricular esquerdo silencioso e rotura a un segundo pseudoaneurisma. Revista Española de Cardiología, v. 58, n. 9, p. 1127–1129, 2005.
MENG, X. et al. Clinical characteristics and outcomes of left ventricular pseudoaneurysm: a retrospective study in a single-center of China. Medicine (Baltimore), v. 96, n. 18, p. e6793, 2017. Disponível em: https://doi.org/10.1097/MD.0000000000006793.
MORENO, R.; GORDILLO, E.; ZAMORANO, J.; ALMERIA, C.; GARCIA-RUBIRA, J.C.; FERNÁNDEZ-ORTIZ, A.; MACAYA, C. Long term outcome of patients with postinfarction left ventricular pseudoaneurysm. Heart, v. 89, n. 10, p. 1144–1146, 2003. Disponível em: https://doi.org/10.1136/heart.89.10.1144.
PETRE, R.; LINKA, A.; JENNI, R.; TURINA, M.I. Surgical treatment of acquired left ventricular pseudoaneurysms. The Annals of Thoracic Surgery, v. 70, n. 2, p. 553–557, 2000. Disponível em: https://doi.org/10.1016/S0003-4975(00)01412-0.
ROPERS, D.; ACHENBACH, S.; PFEIFFER, S. Left ventricular pseudoaneurysm following myocardial infarction. Heart, v. 90, n. 5, p. 555, 2004. Disponível em: https://doi.org/10.1136/hrt.2003.023416.
SCAGLIOLA, R.; ROSA, G.M.; SEITUN, S. Cardiac outpouchings: definitions, differential diagnosis, and therapeutic approach. Cardiology Research and Practice, 2021:6792643, 2021. Disponível em: https://doi.org/10.1155/2021/6792643.
SILBIGER, J. J. et al. Pseudoaneurysm formation in infective endocarditis. Echocardiography (Mount Kisco, N.Y.), v. 30, n. 10, p. E319–E321, 2013. Disponível em: https://doi.org/10.1111/echo.12333.
SINGH, R.; NOLAN, S. P.; SCHRANK, J. P. Traumatic left ventricular aneurysm. Two cases with normal coronary angiograms. JAMA, v. 234, n. 4, p. 412–414, 1975.
SITTA, J.; HOWARD, C.M. Left ventricular pseudoaneurysm: an unexpected finding. Radiology Case Reports, v. 16, n. 3, p. 538–542, 2020. Disponível em: https://doi.org/10.1016/j.radcr.2020.12.028.
TALLARICO, D.; CHIAVARI, P.; MOLLO, P.; PESSA, G.; SCAGLIONE, M.; DE CHAMPS, C.; CARITÀ, P.; MILANI, R.; FISSI, C.; DELFINI, R. Left ventricular pseudoaneurysm: echocardiographic and intraoperative images. Circulation, v. 111, p. e35–e36, 2005. Disponível em: https://doi.org/10.1161/01.CIR.0000153815.87329.1D.
TORCHIO, F.; GARATTI, A.; RONCO, D.; MATTEUCCI, M.; MASSIMI, G.; LORUSSO, R. Left ventricular pseudoaneurysm: the niche of post-infarction mechanical complications. Annals of Cardiothoracic Surgery, v. 11, n. 3, p. 290–298, 2022. Disponível em: https://doi.org/10.21037/acs-2022-ami-25.
YEO, T.C.; MALOUF, J.F.; OH, J.K.; SEWARD, J.B. Clinical profile and outcome in 52 patients with cardiac pseudoaneurysm. Annals of Internal Medicine, v. 128, n. 4, p. 299–305, 1998. Disponível em: https://doi.org/10.7326/0003-4819-128-4-199802150-00010.
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