Minimally invasive repair of a left ventricular pseudoaneurysm after surgical patch reconstruction of an infarct-related free posterior wall rupture: CT-guided intervention

Cardiovasc Intervent Radiol. 2007 Sep-Oct;30(5):1010-2. doi: 10.1007/s00270-007-9054-1. Epub 2007 May 29.

Abstract

Ventricular free wall rupture remains the most serious complication after acute myocardial infarction. In early-recognized, subacute cases a surgical intervention using patches can be lifesaving. However, in the rare case of postoperative patch leakage, a relapse of a pseudoaneurysm may occur. This is the first case in the literature--to the best of our knowledge--describing a minimally invasive strategy using CT fluoroscopic guidance to perform an injection of thrombin into the perfused pseudoaneurysm to seal a leakage. This therapeutical regimen was chosen--in accordance with cardiac surgeons, cardiologists, and interventional radiologists--due to the high risk of adverse event after repeated surgery in this particular patient. The follow-up images showed complete occlusion of the pseudoaneurysm after the thrombin injection. This approach could be discussed in a multidisciplinary setting in similar cases, especially due to the described negligible recurrence rate after successful initial thrombosis after treating femoral pseudoaneurysms, pseudoaneurysms of the pancreatic artery, or even endoleaks after stenting of aneurysms of the aorta.

Publication types

  • Case Reports

MeSH terms

  • Adult
  • Aneurysm, False / complications
  • Aneurysm, False / diagnostic imaging
  • Aneurysm, False / drug therapy*
  • Aneurysm, False / etiology
  • Cardiac Surgical Procedures / adverse effects*
  • Coagulants / administration & dosage*
  • Female
  • Fluoroscopy
  • Heart Aneurysm / complications*
  • Heart Aneurysm / diagnostic imaging
  • Heart Aneurysm / etiology
  • Heart Aneurysm / surgery
  • Humans
  • Injections, Intralesional
  • Myocardial Infarction / complications*
  • Myocardial Infarction / diagnostic imaging
  • Myocardial Infarction / surgery
  • Pericardial Effusion / diagnostic imaging
  • Pericardial Effusion / etiology
  • Pericardial Effusion / surgery
  • Radiography, Interventional / methods*
  • Thrombin / administration & dosage*
  • Time Factors
  • Tomography, X-Ray Computed*
  • Treatment Outcome
  • Ventricular Septal Rupture / complications
  • Ventricular Septal Rupture / diagnostic imaging
  • Ventricular Septal Rupture / etiology
  • Ventricular Septal Rupture / surgery*

Substances

  • Coagulants
  • Thrombin