Hasan KOCATÜRK, Adem KAHRAMAN, Ednan BAYRAM, MEHMET CENGİZ ÇOLAK

Left ventricular pseudoaneuyrsm: A four year follow-up with medical therapy

Yetmişüç yaşında erkek hasta, 4 yıl önce ilerleyici nefes darlığı nedeni ile başvurmuştu. Transtorasik ekokardiyo-grafide sol ventrikül posterolateral duvarda yalancı anevrizmayı düşündüren kavitasyon tespit edildi. Kontrast madde verilerek alınan bilgisayarlı göğüs tomografisinde sol ventrikül posterolateral duvarda içerisinde yoğun trombus olan büyük boyutta bir yalancı anevrizma görüldü. Koroner anjiyografide hem sirkümfleks hem de ön inen arterde ciddi stenozlar vardı. Bulgular daha önce geçirilmiş miyokardial infarktüs sonucu gelişen yalancı anevrizma tanısı ile uyumlu olarak gözlendi. Hasta cerrahi tedaviyi reddetti ve medikal tedavi altına alındı. Dört yıllık izlemde hasta hala hayatta ve klinik olarak hastanın semptomlarında tama yakın düzelme gözlenmiştir.

Sol ventrikül yalancı anevrizması: medikal tedavi ile dört yıllık izlem

dyspnea four years ago. Transthoracic echocardiography revealed a large posterolateral cavity, suspecting an old pseudoaneurysm. Contrast-enhanced computed tomog-raphy of the chest demonstrated a large posterolateral pseudoaneurysm with intracavitary extensive thrombus. Coronary angiography showed severe stenoses in both left circumflex and left anterior descending arteries. These findings were consistent with left ventricular pseudoaneurysm resulting from an old infarction. The surgery was recommended, but the patient refused. Conservative management was initiated with close follow-up appointments. After four years the patient is still alive and had near complete resolution of his symptoms.

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1. Pollak H, Nobis H, Mlczoch J. Frequency of left ventricular free wall rupture complicating acute myocardial infarction since the advent of thrombolysis.Am J Cardiol 199415: 184-6.
2. Niimura H, Mito T, Matsunaga A, Koga S, Akasu K, Morishige N, et al.Left ventricular pseudoaneurysm following acute myocardial infarction.Intern Med 2006;45: 1221-3.
3. Hung MJ, Wang CH, Cherng WJ. Unruptured left ventricular pseudoaneurysm following myocardial infarction.Heart 1998;80: 94-7.
4. Gündoğdu F, Aksakal E, Sevimli S, Kantarcı M. A case of left ventricular pseudoaneurysm: evaluation by left ventriculography and multislice computed tomography. Anatol J Clin İnvestig 2008:2; 174-6.
5. Eren E, Bozbuga N, Toker ME, Keles C, Rabus MB, Yildirim O, et al. Surgical treatment of post-infarction left ventricular pseudoaneurysm: a two-decade experience.Tex Heart Inst J 2007;34: 47-51.
6. Moreno R, Gordillo E, Zamorano J, Almeria C, Garcia-Rubira JC, Fernandez-Ortiz A, et al.Long term outcome of patients with postinfarction left ventricular pseudoaneurysm.Heart 2003;89: 1144-6.
7. Jiang C, Zhao R, Yang X.Six-year follow-up of a left ventricular pseudoaneurysm without surgical repair.Can J Cardiol 2007;23: 739-41.
8. Butz T, Faber L, Langer C, Horstkotte D.Giant left ventricular pseudoaneurysm: a rare complication following left ventricular rupture caused by myocardial infarction.Eur Heart J 2008;29: 143.
9. Bolognesi R, Cucchini F, Lettieri C, Manca C, Visioli O.Left ventricular false aneurysm: an unusually prolonged natural history.Cathet Cardiovasc Diagn 1995;36: 46-52.