Original articleCardiovascularSurgical Treatment of Postinfarction Left Ventricular Pseudoaneurysm
Section snippets
Patients and Methods
From 1986 to 2002, 30 patients underwent surgical treatment of postinfarction LV pseudoaneurysm at Cleveland Clinic. Etiology was confirmed by surgical or pathology reports. Preoperative, operative, and postoperative data were obtained from the prospective Cardiovascular Information Registry (CVIR), which has been approved for research by the Institutional Review Board.
Patients with postsurgical pseudoaneurysm or true postinfarction ventricular aneurysm were excluded. All patients suffered
Clinical Presentation
Left ventricular pseudoaneurysm was diagnosed a median of 50 days (range, 2 to 268) after MI. Eight patients (35%) presented within 2 weeks of infarction. Six (20%) were in New York Heart Association (NYHA) functional class IV, and 8 (27%) were in class III; 22 (73%) presented with heart failure symptoms and 11 (41%) with angina. Only 2 (7%) were asymptomatic.
Diagnostic Testing
Diagnostic investigation of ventricular pseudoaneurysm included contrast ventriculography in 24 patients (83%), transesophageal
Clinical presentation
Clinical presentation of pseudoaneurysm lacks characteristic features. Heart failure was the most frequent presenting syndrome in our experience as well as in that of others [12]. Heart failure is usually refractory to medical management, and nearly half our patients were in NYHA functional class III or IV preoperatively. Heart failure occurs because of loss of stroke volume, underlying ischemic cardiomyopathy, and associated mechanical complications, such as mitral regurgitation or ventricular
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Dr Gillinov discloses that he has a financial relationship with Edwards Lifesciences, Inc.