Eur J Cardiothorac Surg 2006;30:193
© 2006 Elsevier Science NL
Images in cardio-thoracic surgery |
Left ventricular false aneurysm following percutaneus balloon aortic valvuloplasty: magnetic resonance imaging as diagnostic tool
Farzan Filsoufi
*
,
Sacha P. Salzberg,
Parwis B. Rahmanian,
David H. Adams
Department of Cardiothoracic Surgery, Mount Sinai Medical Center, 1190 Fifth Avenue, Box 1028, New York, NY 10029, United States
Received 2 February 2006;
received in revised form 16 March 2006;
accepted 21 March 2006.
* Corresponding author. Tel.: +1 212 659 6813; fax: +1 212 659 6818. (Email: farzan.filsoufi{at}mountsinai.org).
Key Words: False aneurysm • Left ventricle • Balloon aortic valvuloplasty
A 73-year-old female (history of CABG) underwent percutaneus aortic balloon valvuloplasty (PABV) for severe aortic stenosis (Fig. 1
). After discharge she was readmitted with severe congestive heart failure. Magnetic resonance imaging (Fig. 2
) demonstrated a large false aneurysm of the left ventricle at the base of the lateral wall.
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Fig. 1. Patient was considered too high risk for reoperative aortic valve replacement therefore PABV was performed. The retrospective review of cardiac catheterization during PABV showed the guide wire was placed inadvertently against the free left ventricular lateral wall puncturing the left ventricle and leading to ventricular perforation.
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Fig. 2. Magnetic resonance imaging study shows a large false aneurysm (FA) located at the base of the left ventricular lateral free wall with a 1-cm neck. We assume that the presence of pericardial adhesions due to prior CABG procedure prevented classical signs of LV perforation and let to delayed diagnosis. Patient underwent emergent reoperative false aneurysm repair with bovine pericardial patch and aortic valve replacement (predicted mortality by logistic EuroSCORE 76%). Postoperatively she developed biventricular failure progressively and expired despite inotropic support and IABP insertion. (a) Two chamber view; (b–d) four chamber view. LA: left atrium, LV: left ventricle, FA: false aneurysm.
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