Left ventricular pseudoaneurysm: A case report and review of the literature

Left ventricular (LV) pseudoaneurysm is a rare complication that is reported in less than 0.1% of all patients with myocardial infarction. It is the result of cardiac rupture contained by the pericardium and is characterized by the absence of myocardial tissue in its wall unlike true aneurysm which involves full thickness of the cardiac wall. The clinical presentation of these patients is nonspecific, making the diagnosis challenging. Transthoracic echocardiogram and cardiac magnetic resonance imaging are the noninvasive modalities whereas coronary arteriography and left ventriculography are invasive modalities used for the diagnosis. As this condition is lethal, prompt diagnosis and timely management is vital.     

Elusive left ventricular thrombus: Diagnostic role of cardiac magnetic resonance imaging-A case report and review of the literature

Identification of left ventricular mural thrombus (LVT) may be challenging depending on the imaging modality used. We present a case of LVT which was incidentally identified on cine cardiac magnetic resonance imaging (CMR). A sixty-four years old female presented with worsening dyspnea on exertion with troponin elevation. Transthoracic echocardiography (TTE) revealed a dilated left ventricle (LV) and ejection fraction (EF 30%) with thinning and akinesis of inferior/inferolateral wall was noted with basal and mid inferior wall aneurysm, and thrombus was not identified. CMR done to ascertain viability of myocardium revealed a mural thrombus within basal inferior aneurysm. This was not visualized on transthoracic echocardiography with and without use of contrast. She underwent coronary artery bypass grafting, bioprosthetic mitral valve replacement, resection and plication of posterior left ventricular aneurysm with removal of mural thrombus, and was started on anticoagulation with warfarin post-operatively for the apical thrombi. Cardiac magnetic resonance is a well suited imaging modality in detecting LVT due to its high resolution images and is more reproducible than TTE. In our patient, conventional TTE despite administration of echo-contrast agents failed to diagnose the presence of LVT in the basal inferior aneurysm as well as the apical thrombi. Delayed-enhancement CMR provides the greatest sensitivity for detection of left ventricular thrombus, superior to standard transthoracic and contrast-enhanced transthoracic echocardiography.     

Left Ventricular Free-Wall Rupture Occurring During Programmed Ventricular Stimulation in a Patient With Recent Myocardial Infarction

In this report we describe a patient who died during programmed ventricular stimulation due to a rupture of the left ventricular free wall at the site of a recent myocardial infarction. The patient was a 75-year-old male who presented with an extensive anterior wall myocardial infarction complicated by sustained ventricular tachycardia occurring 8 days after admission. Cardiac catheterization revealed total occlusion of left anterior descending coronary artery and an anteroapical aneurysm. The patient died due to electromechanical dissociation during electrophysiological testing 11 days after myocardial infarction. Postmortem examination showed a rupture of the left ventricular free wall at the site of the myocardial infarction and distant from the site of catheter placement. It is suggested that caution be taken in choosing patients for electrophysiological studies who have had recent large myocardial infarctions with ventricular aneurysm.     

超声心动图四维自动左心室容积测定技术在左心室室壁瘤成形术中的应用价值

目的 探讨四维自动左心室容积测定（4D auto LVQ）在室壁瘤左心室成形术中的应用价值。方法 采用4D auto LVQ技术评价7例广泛前壁心肌梗死合并心尖部室壁瘤患者左心室容积和功能,并与心脏MR测量心室容积及室壁瘤成形术后左心室收缩功能比较。结果 5例术前行心脏MR检查,5例行室壁瘤成形术。与二维超声心动图相比,4D auto LVQ测量室壁瘤患者左心室容积与心脏MR检查结果更接近。采用4D auto LVQ技术术前预测左心室收缩功能与术后实际左心室收缩功能接近。结论 4D auto LVQ技术可更精准、快捷地评价左心室容积和收缩功能,为制定室壁瘤成形手术方案提供客观资料。     

Isolated noncompaction of the ventricular myocardium: ultrafast computed tomography and magnetic resonance imaging

This study was undertaken to evaluate the feasibility of ultrafast computed tomography (CT) and magnetic resonance imaging (MRI) for anatomical and pathophysiological diagnosis of isolated noncompaction of the left ventricular myocardium (INVM) compared with other imaging modalities including thallium myocardial imaging. Six patients, three sets of siblings, ranging in age from 13 to 18 years, were included in this study. Two-dimensional echocardiograms revealed numerous prominent trabeculations and deep intertrabecular recesses in one or more ventricular wall segments in all cases. Thallium-201 myocardial imaging disclosed a hypoperfusion area corresponding to the zones where noncompacted ventricular myocardium was localized. Ultrafast CT showed early defects of varying degrees and rate enhancement of the noncompacted ventricular myocardium, implying fibrosis in this area. MRI disclosed inner zones of noncompacted myocardium distinguishable from thin outer zones of compacted myocardium. T2-weighted imaging revealed high intensity areas at the apex of the left ventricle, suggesting disturbed microcirculation due to fibrosis, thrombus formation, and hypokinesis. Cine MRI revealed hypokinesis of the noncompacted ventricular wall during the cardiac cycle. In conclusion, ultrafast CT and MRI provide high-resolution imaging of noncompacted myocardium, and also pathophysiological details regarding this rare disease.     

Ventricular septal rupture,right ventricular dissection,and tricuspid chordae rupture—A rare complication after inferior and right ventricular infarction

A 76‐year‐old man under stable hemodynamic condition was admitted to our hospital for delayed percutaneous coronary intervention following a diagnosis of acute inferior myocardial infarction. Bedside echocardiography revealed ventricular septal rupture at the basal posteroinferior wall with a large left‐to‐right shunt. Right ventricular free‐wall intramyocardial dissection and tricuspid chordae rupture were noted. Coronary angiography demonstrated occlusion of the proximal right coronary artery, which was treated by balloon angioplasty and stenting. While preparing for surgical repair, the patient's overall cardiac and renal function deteriorated and surgery was contraindicated. The patient died 16 days after discharge. © 2014 Wiley Periodicals, Inc. J Clin Ultrasound 43:512–515 2015     

急性心肌梗塞及再灌注的MRI实验研究

目的 探讨急性心肌梗塞及再灌注的ＭＲＩ征象及其病理学基础以及再灌注对心肌梗塞后左室重构的影响,材料和方法 １３只小型猪开胸结扎冠状动脉左前降支制备心肌梗塞动物模型（６只）和民裔缺血再灌注动物模型（７只）于术前,术后７小时,５－７天,１３－１７天和１个月进行ＭＲＩ检查,心脏标本进行病理检查,结果;梗塞组和再灌注组均见左心室前壁及室间胆部Ｔ２ＷＩ上信信号,部分出现心腔内流动信号升高（其中梗塞组５例,再     

乏氏窦瘤破裂的彩色多普勒超声诊断

本组14例乏氏窦瘤破裂（RASV）患者通过彩色多普勒超声（CDU）与手术对照研究，表明：CDU能准确地显示窦瘤的形态、起源部位，破入心腔及血流动力学改变。本组RASV超声表现：（1）二维超声（2－DE）的直接征象：可见乏氏窦扩张呈袋状光带，突入邻近心腔，在破裂的瘤体上可见连续中断的破口；（2）彩色多普勒血流显像（CDFI）：在窦瘤及其破裂口处可见多彩镶嵌的分流信号通过破口进入相应心腔，频谱检测呈连续性双期湍流频谱。CDU还能准确地检出合并室间隔缺损、主动脉瓣返流等。     

介入封堵左前降支建立室壁瘤动物模型

背景:有资料表明,猪的心血管系统的生物学特性与人类有极大的相似性,其代谢、免疫系统、疾病的发生机制等方面与人类有99%的共源性.目的:拟通过介入封堵左前降支建立规范化的猪室壁瘤模型.设计、时间及地点:动物观察实验,于2005-12/2007-07在同济大学附属同济医院功能材料实验室及动物实验中心完成.材料:枫泾家猪13只, 雌雄不拘,体质量30～40 kg.方法:在充分腹腔、静脉麻醉诱导下,对13只家猪行经皮股动脉穿刺,置入7号动脉鞘管,在数字减影血管造影下经鞘管在导丝引导下通过球囊将"WYW"冠状动脉栓塞装置输送至前降支第一对角支开口处远端,扩张球囊,释放栓塞装置,再次行冠脉造影,确认栓塞装置对冠脉前降支已形成可靠的封堵.术中、术后严密心电血压监测并予血管活性药物维持生命体征平稳.主要观察指标:观测心电图、血清心肌酶谱、心肌核素显像、超声心动图、心血管照影及病理学变化.结果:1只动物在术前死于麻醉意外,6只在封堵过程中死于心室颤动,其余6只均存活.术后4周复查冠脉照影显示,远端血流已100%阻塞,左室照影示心尖部及左室前壁室壁运动消失.栓塞前心电监护显示心电图呈正常表现,阻断后即刻出现ST段持续性抬高,R波振幅降低,T波高耸,ST-T融合波出现,胸前导联明显.ST段约2周后降回基线,术后4周可见病理性Q波.术后12 h血清肌钙蛋白测定较术前均有不同程度升高(P<0.01).放射性核素心肌显像可见心尖和左室前壁呈放射性的核素灌注充盈缺损,室壁变薄,有室壁瘤形成.心脏超声显示,6只动物均出现室壁局部节段性收缩运动减弱,以左室前壁及心尖部尤显.苏木精一伊红染色后光镜下观察可见心尖梗死区心肌纤维消失、被胶原纤维所取代,其间有少量毛细血管;右室前壁梗死边缘区有残留心肌纤维核固缩、溶解,除胶原纤维填充外还有较多炎症细胞和毛细血管浸润.结论:应用"WYW"介入栓塞法建立的室壁瘤模型较接近临床病理生理演变过程,效果确切可靠.     

Aortic root dissection with left valsalva sinus perforation detected by transesophageal 3D echocardiography in a patient with Behçet's disease

Behçet's disease (BD) is a multi‐system inflammatory disorder. We report the case of a BD patient with severe aortic root vasculitis. Two‐dimensional transthoracic echocardiography (2DE) images suggested left Valsalva sinus aneurysm ruptured into the left ventricular outflow tract. However, preoperative transesophageal real‐time 3‐dimensional echocardiography (3DE) revealed that the aneurysm‐like structure involved most of the left ventricular outflow tract wall, leading to the diagnosis of aortic root dissection associated with perforation of the left Valsalva sinus and prolapse of the exfoliated endocardium into the left ventricular outflow tract. These findings were confirmed by open heart surgery. 3DE was helpful differentiating aortic root dissection from Valsalva sinus aneurysm rupture, especially by demonstrating the extent of aneurysm‐like structure in the left ventricular outflow tract. © 2013 Wiley Periodicals, Inc. J Clin Ultrasound 42 :59–62, 2014     

Subepicardial aneurysm of the left ventricle

Three patients are presented in whom a subepicardial aneurysm developed as a complication of a myocardial infarction. This aneurysm of the left ventricle is unusual and has 3 distinctive traits: an abrupt interruption of the myocardium that comprises the mouth and typically a narrow neck of the aneurysm; aneurysmal wall comprised of epicardium with or without a thin myocardial layer; and a propensity to rupture spontaneously regardless of the wall components or stage of development. All 3 patients were given a diagnosis using echocardiography and underwent immediate surgical aneurysmectomy. One patient died as a result of renal and respiratory failure postoperatively. The long-term outcome of the other 2 patients was favorable without evidence of additional cardiac rupture or instability.     

速度向量成像与定量组织速度成像技术评价犬急性心肌缺血状态下左心室收缩功能

目的以心导管测量左室压力上升速度最大值( dp/dtmax)为标准,探讨应用速度向量成像(VVI)与定量组织速度成像(QTVI)评价犬急性心肌缺血状态左室收缩功能。方法健康杂种犬6只,开胸后游离左冠状动脉回旋支或前降支,使用自制动脉血管缩窄器制备不同程度冠状动脉狭窄。测量不同血流状况下二尖瓣环水平4个心室壁处(左室间隔、下壁、侧壁、前壁)心肌收缩速度,同时进行心导管检查,测量 dp/dtmax。结果使用VVI技术测量,二尖瓣环水平心肌收缩速度与左室 dp/dtmax呈正相关(r=0.883),P<0.001;使用QTVI技术测量,二尖瓣环处心肌收缩速度与 dp/dtmax呈正相关(r=0.715),P<0.001,两相关系数行Z检验,Z=2.981,P=0.0028。结论VVI或QTVI技术测定二尖瓣环水平心肌收缩速度均是评价左心室收缩功能的好方法。相对于QTVI而言,VVI与 dp/dtmax的相关性更高,可能更加适用于对左室收缩功能的测定。     

非典型心尖肥厚型心肌病的诊断学特征

目的探讨非典型心尖肥厚型心肌病的诊断学特征。 方法回顾性分析济宁医学院附属医院心内科收治的1例非典型心尖肥厚型心肌病患者2018年6月至2022年4月的临床资料，总结非典型心尖肥厚型心肌病的诊断学特征，并复习相关文献。 结果患者既往多次发病时临床表现均为胸闷、胸痛。心电图提示V₂-V₆导联T波倒置，最大振幅0.8 mV。超声心动图及冠状动脉造影检查结果未见明显异常。心脏功能磁共振成像示左心室心尖心肌相对增厚，左心室舒张末期基底段下壁厚度为6.85 mm，心尖段下壁厚度为12.17 mm，心尖段下壁与其后段下壁厚度之比为1.78，舒张期左心室呈"黑桃尖"样改变，伴左心室运动异常。患者诊断为心尖肥厚型心肌病，给予琥珀酸美托洛尔、盐酸曲美他嗪对症治疗，随访3个月，无特殊不适。 结论非典型心尖肥厚型心肌病患者，特别是早期无症状或无特异性临床表现时易被漏诊，需综合心电图、影像学等手段方能明确诊断，尤其是完善心脏磁共振成像检查将有助于减少误诊率。     

定量组织速度成像和组织追踪对正常人左室壁运动的研究

目的应用定量组织多普勒速度成像(quantitative tissue velocity imaging,QTVI)和组织追踪法(tissue tracking,TT)分析正常人左室心肌长轴方向舒缩运动的特点,探讨QTVI和TT技术评价心肌运动的应用价值.方法获取标准心尖位左室长轴切面、两腔切面及四腔切面,分别应用QTVI和TT技术,对30例正常人左室各节段长轴方向舒缩运动的特点进行测定分析.结果正常人每个心动周期中,室壁运动速度曲线均包括收缩波(S)、快速充盈波(E)和左房收缩充盈波(A)三个主要运动波,以及等容舒张波(IR)和等容收缩波(IC).正常人心肌不同节段收缩期和舒张期运动速度呈一梯度.同一室壁从心底向心尖部,运动速度和位移逐渐降低.同一水平不同节段心肌运动速度和位移也有差别.结论正常人室壁运动存在特有的不均一性,QTVI和TT对评价局部心肌运动具有很好的应用价值,进而为诊断冠心病开辟一种新途径.     

Successful nitinol stent implantation in a large coronary aneurysm: post-interventional patency assessment by magnetic resonance imaging

Nitinol stents are thought to exhibit reduced occurrence of artifacts and may be suitable for magnetic resonance imaging (MRI) evaluation of stent localization and in-stent patency even in coronary-sized stent grafts. A 54-year-old male patient presented with a large coronary post-stenotic aneurysm of the right coronary artery (RCA) beside significant stenoses of the left circumflex coronary artery (LCX) and the left anterior descending coronary artery (LAD) with aneurysm formation. After implantation of stent grafts to the LAD and LCX, two polymermembrane-covered nitinol stent grafts were placed into the RCA. A control MR examination 7 days following the RCA intervention showed successful occlusion of the former aneurysm, no post-interventional endoleak, and bright signal within the stent indicating stent patency. Thus, coronary MRI after nitinol stent implantation in coronary aneurysms is feasible for post-interventional early imaging control at least as far as the exclusion of possible endoleaks is concerned.     

主动脉球囊反搏在急性心肌梗死所致的心源性休克和心脏破裂中的应用

目的 对采用主动脉内球囊反搏（IABP）治疗的心源性休克和心脏破裂病人的住院死亡情况进行回顾性分析。方法 对心源性休克和心脏破裂的28例病人，均安装IABP，其中20例进行了冠状动脉造影。13例接受了冠状动脉成形术（PTCA），冠脉旁路移植术（CABG）或心脏外科手术。结果 1例因急诊血管成形失败而行急诊CABG成功，11例急诊血管成形（直接PTCA）开通了梗死相关动脉（IRA），12例（42.9%)存活，16例死亡（57.1%)；11例因休克死亡；4例心脏破裂因没有手术干扰的时机死亡；1例游离壁破裂因心肌坏死面积过大死于手术台上；还有1例病人在出院7d后死于室颤，在所有无心脏破裂的心源性休克病人中，与接受PTCA和CABG的病人相比，未接受PTCA和CABG的病人的死亡率较高（81.8%vs16.7%)。所有心脏破裂的病人无一存活，死亡率100%。结论 使用IABP对于急性心肌梗死（AMI）所致的心源性休克有显著的效果。但仅使用IABP结合常规治疗而不开通IRA并不能提高这些病人的生存率。心脏破裂的病人若不能及时修补缺损，使用IABP仅能延长病人的存活时间。不能改善病人的生存率。     

非体外循环下左心室重建联合冠状动脉旁路移植术治疗左心室室壁瘤

目的评价在非体外循环下行左心室重建术＋冠状动脉旁路移植术治疗左心室室壁瘤的效果。方法左心室室壁瘤患者103例,在非体外循环下先行冠状动脉旁路移植术,其中乳内动脉与前降支吻合80例,大隐静脉-前降支或其他血管吻合21例,2例未搭桥,然后用2-0聚丙烯线围绕前间壁及心尖部室壁瘤基底部全层荷包缝合室壁瘤及室壁瘤的游离壁以消除死腔。结果术后发生低心排综合征10例,脑卒中2例,开胸止血2例,室性心律失常3例,死亡3例;手术前左心室舒张末内径（66.59±9.76）mm,术后减少到（50.00±5.30）mm（P〈0.05）;左心室舒张末容积由术前（165.20±59.48）mL减少到（85.60±23.70）mL（P〈0.05）;左心室射血分数由术前（35.70±0.05）%增加到（50.00±0.04）%（P〈0.05）。结论非体外循环左心室重建术＋冠状动脉旁路移植术治疗左心室室壁瘤手术操作简单,并发症少,近期疗效良好。     

Primary cardiac hydatid disease: cross-sectional imaging features

BACKGROUND: Although hydatid disease is common, individual series are usually not large as far as primary cardiac hydatid disease is concerned. We believe this study is the largest series of primary cardiac hydatid disease for which cross-sectional imaging is available. Methods. We reviewed the radiologic and medical records of 9 pathologically proven cases of primary cardiac hydatid disease. Echocardiography, computed tomography (CT), and magnetic resonance imaging (MRI) were used. In 5 patients, all three modalities were used, and in 4 only CT was available. RESULTS: Three types of cardiac involvement (pericardial, left ventricular, and right atrial wall) were detected. The cysts showed daughter cyst formation, detached parasitic membrane, rupture, segmental calcification, and end-stage calcification. CONCLUSION: Echocardiography is useful in detecting the cystic nature. Computed tomography best shows the wall calcification. Magnetic resonance imaging depicts the exact anatomic location and nature of the internal and external structures and is the modality of posttreatment follow-up.     

多排CT诊断肥厚型心肌病：与MRI对照

目的 观察多排CT（MDCT）评价肥厚型心肌病（HCM）患者的心脏形态、功能和心肌纤维化等的准确性。方法 对临床诊断为HCM的60例患者行CT动脉期、延迟期扫描及心脏MR形态、延迟强化检查。比较二者在左心室室壁厚度、射血分数（EF）、每搏输出量（SV）、左心室心肌质量（LVM）、心输出量（CO）、心脏指数（CI）、舒张末期左心室容积（EDV）、收缩末期左心室容积（ESV）、延迟强化病灶定性及定量诊断方面的异同。结果 60例患者共1020个心肌节段,CT与MRI所测左心室室壁厚度的相关性好（r=0.895,P<0.001）,且CT测量的心功能参数均与MRI结果呈正相关。延迟增强检查证实CT与MR在检出心肌纤维化病灶方面具有高度相关性（r=0.98,P<0.01）。结论 心脏CT检查可提供HCM患者心肌冠状动脉的形态及功能信息。     

磁共振追踪标记技术识别心肌梗死后左室壁运动失调的临床应用

目的探讨磁共振Tagging成像对于诊断心肌梗死后左室室壁瘤收缩运动失调区域的临床价值。方法12例既往有典型心肌梗死病史和心电图改变,经冠状动脉造影确诊为“冠心病,左室室壁瘤”的慢性心肌梗死后患者,行心脏磁共振Tagging序列和延迟增强序列扫描对照检查。结果10例患者磁共振Tagging序列获得良好成像效果(成功率83%),能够识别出室壁收缩的三种运动形态:收缩存在、收缩消失、反常收缩。通过与延迟强化室壁节段的对照观察,我们发现有6/16个节段的收缩消失区域并未显示出心肌梗死的特征改变,室壁未见变薄或异常强化。同时我们还发现有5个节段的室壁,虽然纵向短缩率消失,而辐射向心收缩力仍然存在。结论磁共振Tagging技术能够较明确识别室壁瘤或远隔室壁节段的不同收缩状态,对于室壁瘤的外科治疗能提供重要的诊断信息。