Left Ventricle Postinfarction Pseudoaneurysm: Anatomical Forms and Surgical Management

  1. Garrido, J. M.
  2. Ferreiro, A.
  3. Rodríguez-Vázquez, José Francisco 2
  4. Prada, P.
  5. Verdugo López, Samuel 1
  6. Silva, J.
  7. López-Checa, S.
  8. Sánchez-Montesinos, I.
  1. 1 Departamento de Anatomía y Embriología Humana, Facultad de Óptica y Optometría, Universidad Complutense, Madrid, España
  2. 2 Departamento de Anatomía y Embriología Humana II, Facultad de Medicina, Universidad Complutense de Madrid, Madrid, España
Revista:
Surgical Science

ISSN: 2157-9407,  2157-9415

Año de publicación: 2014

Volumen: 05

Número: 04

Páginas: 138-145

Tipo: Artículo

DOI: 10.4236/SS.2014.54025 GOOGLE SCHOLAR lock_openAcceso abierto editor

Otras publicaciones en: Surgical Science

Resumen

Introduction: Left Ventricle Postinfarction Pseudoaneurysm (LVPS)—false aneurysm occurs after a free-wall rupture contained by the adjacent pericardium. LVPS lacks the normal structure of the ventricular wall and disrupts the normal chamber anatomy. However, the natural history, clinical presentation and surgical outcome are still unclear. For that reason, it is necessary to describe the most relevant anatomical characteristics of LVPS and the appropriate surgical strategies currently applied. Methods: We reviewed the anatomical characteristics of several patients diagnosed of LVPS and the surgical technique performed. In this work two different anatomical types of LVPS are described in detail, with the surgical and structural implications for left ventricle reconstruction. Results: There are two different anatomical forms of LVPS: 1) Typical pseudoaneurysm, with a small gateway neck between the Left Ventricle and the false aneurysm chamber (Figure 1(A)); 2) Atypical pseudoaneurysm, in which the anatomical defect is bigger, without well-defined edges, extends over a large segment of infarcted and thinned myocardial tissue. In both cases, the therapeutics targets and the surgical techniques used were directed to restore the normal geometry of Left Ventricle, keeping the optimal mitral valve function. Conclusions: The surgical key-step is to preserve or to remodel the ventricular chamber anatomy. This fact restores the ventricular geometry, not only removing the wall discontinuity that generated the pseudoaneurysm. Nevertheless, final prognosis depends on the underlying ischemic cardiomyopathy and mechanical complications, such us mitral regurgitation or ventricular septal defect.

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