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Banisauskaite A, Velavan P, Hasleton J, et al. Myocardial rupture and left ventricular pseudoaneurysm due to late STEMI presentation during the COVID-19 pandemic lockdown: a classical case report. Eur Heart J Case Rep. 2021;5(7):ytab253doi: 10.1093/ehjcr/ytab253.
Banisauskaite, A., Velavan, P., Hasleton, J., Mediratta, N., Arzanauskaite, M., & Binukrishnan, S. (2021). 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, 5(7), ytab253. https://doi.org/10.1093/ehjcr/ytab253
Banisauskaite, Audra, et al. "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 vol. 5,7 (2021): ytab253. doi: https://doi.org/10.1093/ehjcr/ytab253
Banisauskaite A, Velavan P, Hasleton 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. Eur Heart J Case Rep. 2021 Jul 18;5(7):ytab253. doi: 10.1093/ehjcr/ytab253. eCollection 2021 Jul. PMID: 34377907; PMCID: PMC8343434.
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Eur Heart J Case Rep. 2021 Jul 18;5(7):ytab253. doi: 10.1093/ehjcr/ytab253. eCollection 2021 Jul.

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

Audra Banisauskaite, Periaswamy Velavan, Jonathan Hasleton, Neeraj Mediratta, Monika Arzanauskaite, Sukumaran Binukrishnan

Affiliations

  1. Radiology Department, Liverpool Heart and Chest Hospital NHS Foundation Trust, Thomas Drive, Liverpool L14 3PE, UK.
  2. Radiology Department, Lithuanian University of Health Sciences, Eiveni? str. 2, Kaunas 50161, Lithuania.
  3. Cardiology Department, Liverpool Heart and Chest Hospital NHS Foundation Trust, Thomas Drive, Liverpool L14 3PE, UK.
  4. Cardiac Surgery Department, Liverpool Heart and Chest Hospital NHS Foundation Trust, Thomas Drive, Liverpool L14 3PE, UK.
  5. Cardiovascular Program ICCC - Research Institute Hospital de la Santa Creu i Sant Pau, IIB-Sant Pau, Carrer de Sant Quintí, 89, 08041 Barcelona, Spain.

PMID: 34377907 PMCID: PMC8343434 DOI: 10.1093/ehjcr/ytab253

Abstract

BACKGROUND: Left ventricular (LV) pseudoaneurysm is a serious and rare complication of myocardial infarction (MI). It occurs when an injured myocardial wall ruptures and is contained by overlying adherent pericardium or scar tissue, most commonly it develops in patients with late presentation of MI and delayed revascularization.

CASE SUMMARY: A 64-year-old man presented to the emergency department with intermittent central chest pain radiating to back and neck and increasing on deep inspiration, which was considered to be of musculoskeletal origin for a week, but worsened despite medications. Electrocardiography showed features of ST-elevation MI; a circumflex artery occlusion was found on coronary angiogram and angioplasty was performed. Cardiovascular magnetic resonance (CMR) revealed features of healed lateral wall rupture with adherent parietal pericardium and the patient was managed conservatively. Two months later the patient returned with severe chest pain; echocardiogram and cardiac computed tomography showed significant interval progression of the pseudoaneurysm. Aneurysmectomy was performed, after which the patient recovered and had none of the previous symptoms since. Follow-up CMR study revealed improvement of LV systolic function.

DISCUSSION: A rare case of post-infarction LV pseudoaneurysm was reported. Multimodality imaging helped to detect and to differentiate this complication from the true aneurysm and to follow it up and plan the treatment. Conservative treatment was not effective in this case as the pseudoaneurysm progressed; aneurysmectomy helped to improve LV systolic function.

© The Author(s) 2021. Published by Oxford University Press on behalf of the European Society of Cardiology.

Keywords: Case report; Complication; Multimodality imaging; Myocardial infarction; Pseudoaneurysm

References

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