Left ventricular aneurysm
| Left ventricular aneurysm | |
 | |
|---|---|
| Left ventricular aneurysm. |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Associate Editor in Chief: Cafer Zorkun, M.D., Ph.D. [2]
Overview
Left ventricular aneurysm (LVA) is a sequela to myocardial infarction which occurrs in 10% to 30% of patients surviving an acute myocardial infarction.
Classification of Left Ventricular Aneurysms
Left ventricular aneurysms are classified as true and false aneurysms. While both true aneurysms and false (pseudo) ventricular aneurysms are the sequelae of myocardial infarction, their etiology, pathologic findings, diagnostic findings, and treatment are different.
True Left Ventricular Aneurysm
A true left ventricular aneurysm has an aneurysmal sac which contains the endocardium, epicardium, and thinned fibrous tissue (scar) that is a remnant of the left ventricular muscle. A true left ventricular aneurysm, particularly if small, may cause few or any symptoms and is compatible with prolonged survival.
False Left Ventricular Aneurysm or Pseudoaneurysm
Unlike a true aneurysm, which contains some myocardial elements in its wall, the walls of a false aneurysm are composed of organized hematoma and pericardium and lack any element of the original myocardial wall. A false aneurysmal sac represents a pericardium that contains a ruptured left ventricle.
- An important difference is the lower potential for rupture of a true aneurysm compared with a false aneurysm.
- Rupture of a true aneurysm is an uncommon phenomenon; therefore, surgical resection is necessary only when refractory angina pectoris, congestive heart failure, systemic embolization, or refractory arrhythmias are present.
- In contrast, false aneurysms may rupture and require surgical repair.
Diagnosis
ECG
True aneurysms distort the shape of the left ventricle during both diastole and systole, and the motion of the aneurysmal segment is paradoxical. This can be associated with ST changes including ST elevation, particularly at high heart rates as might be encountered during exercise.
Radiographic Findings
(Radiological Images Courtesy of RadsWiki)
Chest X Ray
The presence of a discrete bulge in the heart anteriorly is suggestive of a true aneurysm.
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Calcified left ventricular aneurysm -
Calcified left ventricular aneurysm
Chest CT Scan
- True aneurysms will often have a wide neck and are often apical in location.
- False aneurysms will often have a narrow neck and are often posterior diaphragmatic in loccation.
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Calcified left ventricular aneurysm -
Calcified left ventricular aneurysm -
Calcified left ventricular aneurysm
Pathology Findings
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Left ventricular aneurysm
Images shown below are courtesy of Professor Peter Anderson DVM PhD and published with permission. © PEIR, University of Alabama at Birmingham, Department of Pathology
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Left Ventricle Aneurysm: Gross natural color horizontal section apex of left ventricle with aneurysmal dilation and mural thrombus. A large scar tissue in myocardium. -
Left ventricular aneurysm. -
Heart; old myocardial infarction with aneurysm formation
References
- Kumbasar, Basak, Wu, Katherine C., Kamel, Ihab R., Lima, Joao A. C., Bluemke, David A. Left Ventricular True Aneurysm: Diagnosis of Myocardial Viability Shown on MR Imaging. Am. J. Roentgenol. 2002 179: 472-474.
- Eli Konen, Naeem Merchant, Carlos Gutierrez, Yves Provost, Linda Mickleborough, Narinder S. Paul, and Jagdish Butany. True versus False Left Ventricular Aneurysm: Differentiation with MR Imaging—Initial Experience. Radiology 2005 236: 65-75.
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