Giant Left Ventricular Pseudoaneurysm in an Adolescent Boy

Volume 1, Oct 2012

Trinath Kumar Mishra MD, DM, Chandrakanta Mishra, MD, DM, Cuttack, Odisha, India

J Clin Prev Cardiol 2012;1(4):203-4

A 16 years old boy presented with history of shortness of breath on exertion for last 6 months. There was no history of any fever, cough or chest pain.

comOn examination, he was found to have pulsatile precordium with accentuated heart sounds and presence of pansystolic murmur (grade 4/6) at apex. ECG was normal. Chest X-ray revealed moderate cardiomegaly. Echocardiography revealed a huge mass present lateral and posterior to LV and LA, which was communicating with LV. CT thorax was showing the mass. CAG revealed normal coronaries. IV angiography confirmed the mass to be a pseudoaneurysm. No obvious cause could be found out. There was no history of AMI, trauma or infective endocarditis.

We planned to send the patient to cardiothoracic surgery for further treatment. Unfortunately the patient succumbed on fifth day of admission.

1. Approximately 95% of the LV pseudoaneurysm cases present in the old age, the etiology being ischemic heart disease mainly. This case presented in adolescent age and without any previous history of any predisposing factors
2. Between 3.5% and 20% of patients of myocardial infarction develop true aneurysms of the left ventricle (1).The incidence varies, depending on whether anatomic or angiographic criteria are used in the diagnosis. The ability to detect such aneurysms was poor until recently, so it is likely that many were not detected. The increased number of cases uncovered recently by noninvasive diagnostic measures supports this assumption. Transmural infarction was the most common cause of these aneurysms, followed closely by cardiac surgery and trauma. Infection and inflammation were the next most frequent causes. Finally, there was a rare group of aneurysms, most of which were related to preexisting structural defects (2,3).

1. Faxon DP, Ryan TJ, Davis KB, Mccabe CH, Myers W, Lesperance J, Shaw R, Tong TGL. Prognostic significance of angiographically documented left ventricular aneurysm from the coronary artery surgery study (CASS). Am J Cardiol. 1982; 50:157–64.
2. Abrahams DG, Barton CJ, Cockshott WP, Edington GM, Weaver EJM. Annular subvalvular left ventricular aneurysms. Q J Med. 1962; 31:345–60.
3. Chesler E, Joffe N, Schamroth L, Meyers A. Annular subvalvular left ventricular aneurysms in the South African bantu. Circulation. 1965; 32:43–51.