Rie Aoyama, Yuta Fujimoto, Shinichi Okino, Shigeru Fukuzawa, Kenji Mogi
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引用次数: 0
Abstract
Left ventricular (LV) pseudoaneurysm is a rare complication that occurs shortly after myocardial infarction or previous cardiac surgery. We present here a case of an elderly patient with an LV pseudoaneurysm that developed over a long period of time after Dor operation. An 83-year-old man with rapid LV enlargement 18 years after Dor operation presented with dyspnea. We diagnosed his mass as an LV pseudoaneurysm using multiple non-invasive imaging modalities. The suture between the patch and the LV myocardium became fragile and detached over time. However, due to adhesion in the thorax and slow blood flow, the enlargement stopped. Surgery was considered, but due to his age and renal dysfunction, he did not undergo surgery. Conservative treatment with antihypertensive and heart failure therapy was continued. Clinical manifestations of LV pseudoaneurysm vary from asymptomatic to signs of heart failure and even sudden death. Surgery is recommended for LV pseudoaneurysm because of the high risk of rupture, but conservative treatment may be an option that has been developed long after surgery in the era of an increasing number of elderly OMI or post-cardiac surgery patients. Proper diagnosis using multiple imaging modalities may lead to the avoidance of this devastating complication.
左心室假性动脉瘤是一种罕见的并发症,多发生在心肌梗死或既往心脏手术后不久。我们在此介绍一例在 Dor 手术后长期发展为左心室假性动脉瘤的老年患者。一名 83 岁的男性患者在 Dor 手术后 18 年左心室迅速增大,并伴有呼吸困难。我们采用多种非侵入性成像方法诊断其肿块为左心室假性动脉瘤。随着时间的推移,补片与左心室心肌之间的缝合线变得脆弱并脱落。然而,由于胸腔粘连和血流缓慢,肿大停止了。曾考虑过手术治疗,但由于他的年龄和肾功能不全,他没有接受手术治疗。他继续接受高血压和心衰的保守治疗。左心室假性动脉瘤的临床表现多种多样,从无症状到出现心力衰竭症状,甚至猝死。由于左心室假性动脉瘤破裂的风险很高,因此建议进行手术治疗,但在老年 OMI 或心脏手术后患者越来越多的时代,保守治疗可能是手术后很长时间才发展起来的一种选择。使用多种成像模式进行正确诊断可避免这种破坏性并发症的发生。
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