Cardiac CT and MRI guide surgery in impending left ventricular rupture after acute myocardial infarction
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BioMed Central
Open Access
Case report
Cardiac CT and MRI guide surgery in impending left ventricular rupture after acute myocardial infarction Jens Vogel-Claussen*1, Jan Skrok1, Elliot K Fishman1, João AC Lima2, Ashish S Shah3 and David A Bluemke4 Address: 1Johns Hopkins University School of Medicine, Russell H. Morgan Department of Radiology and Radiological Science, Baltimore, MD, USA, 2Johns Hopkins University School of Medicine, Department of Cardiology, Baltimore, MD, USA, 3Johns Hopkins University School of Medicine, Department of Surgery, Division of Cardiac Surgery, Baltimore, MD, USA and 4National Institutes of Health, Department of Radiology and Imaging Sciences, Bethesda, MD, USA Email: Jens Vogel-Claussen* - [email protected]; Jan Skrok - [email protected]; Elliot K Fishman - [email protected]; João AC Lima - [email protected]; Ashish S Shah - [email protected]; David A Bluemke - [email protected] * Corresponding author
Published: 12 August 2009 Journal of Cardiothoracic Surgery 2009, 4:42
doi:10.1186/1749-8090-4-42
Received: 16 March 2009 Accepted: 12 August 2009
This article is available from: http://www.cardiothoracicsurgery.org/content/4/1/42 © 2009 Vogel-Claussen et al; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Abstract We report the case of a 67 year-old patient who presented with worsening chest pain and shortness of breath, four days post acute myocardial infarction. Contrast enhanced computed tomography of the chest ruled out a pulmonary embolus but revealed an unexpected small subepicardial aneurysm (SEA) in the lateral left ventricular wall which was confirmed on cardiac magnetic resonance imaging. Intraoperative palpation of the left lateral wall was guided by the cardiac MRI and CT findings and confirmed the presence of focally thinned and weakened myocardium, covered by epicardial fat. An aneurysmorrhaphy was subsequently performed in addition to coronary bypass surgery and a mitral valve repair. The patient was discharged home on post operative day eight in good condition and is feeling well 2 years after surgery.
Background The formation of left ventricular (LV) myocardial aneurysms is one of several potentially life-threatening complications post acute myocardial infarct (AMI). These aneurysms are traditionally divided into two main groups: true and false aneurysms. While true aneurysms have a wide mouth and the wall is comprised of infracted/ fibrous tissue [1], false aneurysms represent complete ruptures of the myocardial wall. They have a narrow neck and are contained by pericardium. In contrast to true aneurysms, false aneurysms have a dismal prognosis. Therefore, fast and accurate diagnosis and treatment can be life saving [2].
Impending wall ruptures and thus precursors to false aneurysms are called subepicardial aneu
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