Left ventricular aneurysm
| Left ventricular aneurysm | |
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|---|---|
| Calcified left ventricular aneurysm. (Image Courtesy of RadsWiki) |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Associate Editor in Chief: Cafer Zorkun, M.D., Ph.D. [2]
Left ventricular aneurysm (LVA) is a common sequela to myocardial infarction, occurring in 10% to 30% of patients surviving an acute myocardial infarction.
Both true aneurysms and false ventricular aneurysms are the sequelae of myocardial infarction. However, their etiology, pathologic findings, diagnostic findings, and treatment are different.
- True ventricular aneurysm is a chronic complication of myocardial infarction.
- A true aneurysmal sac contains the endocardium, epicardium, and thinned fibrous tissue (scar) that is a remnant of the left ventricular muscle, whereas a false aneurysmal sac represents a pericardium that contains a ruptured left ventricle.
- A true aneurysm, particularly if small, may cause no symptoms and is compatible with prolonged survival.
- 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.
- 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.
- A true aneurysm has a wide neck, and the diameter of the neck is comparable with the maximal diameter of the aneurysm.
Plain film
- One of the common imaging findings for differentiating true aneurysms from false aneurysms is location, which may be identified on a conventional chest radiograph.
- The presence of a discrete bulge in the heart anteriorly is suggestive of a true aneurysm.
Computerized Tomography
- True aneurysms will have a wide neck and are often apical in location.
- False aneurysms will have a narrow neck and are often posterior diaphragmatic in loccation.
Radiographic Findings
(Radiological Images Courtesy of RadsWiki)
Chest X Ray
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Calcified left ventricular aneurysm -
Calcified left ventricular aneurysm
Chest CT Scan
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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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