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We report the clinical case and the infrequent image of a patient developing a ventricular aneurysm following a myocardial infarction. We take advantage of this clinical case to recall some differences between aneurysm and pseudo-aneurysm with a very different prognosis.

Three types of cardiac outpouchings are encountered on cardiovascular imaging: diverticula, aneurysms and pseudoaneurysms. The underlying physiology, imaging findings, risk of rupture, and optimal treatment varies for each and a correct diagnosis is critical. We report a case of a rare, incidentally discovered right ventricular aneurysm that was characterized by transthoracic echocardiogram, computed tomography, and cardiac MRI. The types of cardiac outpouchings are reviewed, and we discuss the selection of imaging modality, keys to distinguishing the outpouchings, and management strategies.

BACKGROUND: Takotsubo syndrome (TS) is a reversible left ventricular (LV) systolic dysfunction occurred mostly in post-menopausal women after an emotional or physical stress. The exact mechanism has yet to be found. In clinical settings, TS should be differentiated from myocardial infarction (MI) due to totally different management protocols. Several diagnostic criteria are available, but mayo clinic criteria is the most widely used. Prognosis of TS is favorable and the recurrence and mortality rates are low. Treatment is mostly supportive and after a few weeks, most of patients’ electrocardiography (ECG) and echocardiographic findings will be normalized, though to its benign course, TS can cause some complications. Intra-myocardial dissection and LV apical aneurysm, as a complication of TS has never been reported yet and was just announced in rare cases of MI.CASE REPORT: Our patient was a 32-year-old aphasic woman referring with palpitation and chest discomfort. Further examinations after exclusion of MI revealed TS leading to LV apical aneurysm and intra-myocardial dissection.CONCLUSION: Intra-myocardial dissection should be considered as one of the rarest TS complications. Several studies are necessary for defining the exact pathophysiological mechanisms.

Background: Surgical ventricular restoration (SVR) has been performed to treat left ventricular (LV) aneurysm. However, there is limited analysis of changes in LV shape. This study aimed to evaluate the changes in LV shape induced by SVR and the effects of SVR on LV size and function for LV aneurysm. Methods: Between April 2006 and March 2015, 18 patients with dyskinetic (dyskinetic group) and 12 patients with akinetic (akinetic group) postinfarction LV anterior aneurysm receiving SVR with the Dor procedure at Chinese People's Liberation Army General Hospital were enrolled in this study. A retrospective analysis was carried out using data from the echocardiography database. LV shape was analyzed by calculating the apical conicity index (ACI). LV end-diastolic volume index, end-systolic volume index, and ejection fraction (EF) were measured. One-way analysis of variance was used to compare means at different time points within each group. Results: Within one week after SVR, LV shape became more conical in the two groups (ACI decreased from 0.84 ± 0.13 to 0.69 ± 0.11 [t = 5.155, P = 0.000] in dyskinetic group and from 0.73 ± 0.07 to 0.60 ± 0.11 [t = 2.701, P = 0.026] in akinetic group; LV volumes were decreased significantly and became closer to normal values and EF was improved significantly in the two groups). On follow-up at least one year, LV shape remained unchanged in dyskinetic group (ACI increased from 0.69 ± 0.11 to 0.74 ± 0.12, t = −1.109, P = 0.294), but became more spherical in akinetic group (ACI significantly increased from 0.60 ± 0.11 to 0.75 ± 0.11, t = −1.880, P = 0.047); LV volumes remained unchanged in dyskinetic group, but increased significantly in akinetic group and EF remained unchanged in the two groups. Conclusions: SVR could reshape LV to a more conical shape and a more normal size and improve LV function significantly early after the procedure in patients with dyskinetic or akinetic postinfarction LV anterior aneurysm. However, LV tends to be more spherical and enlarged in the akinetic group on at least 1-year follow-up.

BACKGROUND: Takotsubo syndrome (TS) is a reversible left ventricular (LV) systolic dysfunction occurred mostly in post-menopausal women after an emotional or physical stress. The exact mechanism has yet to be found. In clinical settings, TS should be differentiated from myocardial infarction (MI) due to totally different management protocols. Several diagnostic criteria are available, but mayo clinic criteria is the most widely used. Prognosis of TS is favorable and the recurrence and mortality rates are low. Treatment is mostly supportive and after a few weeks, most of patients' electrocardiography (ECG) and echocardiographic findings will be normalized, though to its benign course, TS can cause some complications. Intramyocardial dissection and LV apical aneurysm, as a complication of TS has never been reported yet and was just announced in rare cases of MI. CASE REPORT: Our patient was a 32-year-old aphasic woman referring with palpitation and chest discomfort. Further examinations after exclusion of MI revealed TS leading to LV apical aneurysm and intra-myocardial dissection. CONCLUSION: Intra-myocardial dissection should be considered as one of the rarest TS complications. Several studies are necessary for defining the exact pathophysiological mechanisms. [ABSTRACT FROM AUTHOR]

Copyright of Hungarian Medical Journal / Orvosi Hetilap is the property of Akademiai Kiado and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

A sinus of Valsalva aneurysm (SVA) is an abnormal dilation between the aortic valve annulus and sinotubular junction resulting from weakness in the elastic lamina. In the vast majority of cases, SVAs are asymptomatic and are incidentally detected on echocardiogram imaging. In some cases, they can rupture and lead to an intracardiac shunt. Sudden rupture of a high-flow aneurysm can lead to significant hemodynamic compromise and a high fatality rate if not diagnosed early and intervened upon. We present the case of a 68-year-old male who presented with symptoms of heart failure and later rapidly deteriorated due to a sudden spontaneous rupture of the SVA leading to cardiogenic shock. In our case, timely identification and intervention led to a good outcome for our patient. We also present echocardiogram images and videos to educate the readers further about diagnosing SVA. With this case report, we would like to help clinicians and researchers expand their understanding of the condition and treatment outcomes., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2023, Dadana et al.)

Apical hypertrophic cardiomyopathy (ApHCM) can result in the formation of a left ventricular apical aneurysm and progressive myocardial fibrosis, which is associated with a worse prognosis. We present the case of a 76-year-old man previously diagnosed with ApHCM seven years ago, who has been under clinical follow-up. Serial cardiac magnetic resonance (CMR) imaging was performed in 2013 and 2020 due to suspected apical aneurysm formation based on echocardiographic evaluation. The 2020 CMR imaging revealed an increase in myocardial fibrosis observed through late-gadolinium enhancement images and, for the first time, a small apical aneurysm that was not clearly visualized on two-dimensional echocardiography. The time course leading to the development of an ApHCM aneurysm is not well-defined and may impact the clinical course., Competing Interests: Conflicts of interest: The authors declare that they have no conflicts of interest

Current surgical management of restrictive ischaemic mitral regurgitation (IMR) includes mitral valve annuloplasty (MVA) using an undersized ring when the mechanism is secondary to leaflet restriction. In our experience, MVA alone is inadequate to eliminate mitral incompetence in these patients. We report the ‘Down-Under Repair’ as an adjunctive concept for the treatment of a subset of patients with restrictive IMR and associated inferobasal left ventricular aneurysm. The ‘Down-Under Repair’ reduces mitral leaflet restriction by approximating the origin of the posterior papillary muscle towards the mitral annulus. Midterm results demonstrated sustained valvular competence and symptomatic improvement. [ABSTRACT FROM AUTHOR]

Isolated congenital aneurysm of the muscular interventricular septum is rare. We present a patient with congenital aneurysm of the basal muscular ventricular septum, who also develops conduction abnormalities with first-degree heart block, right bundle branch block, and left posterior fascicular block. The case details the natural history of the aneurysm over a 10-year period follow-up during which the patient remained asymptomatic with evidence of regression of the aneurysm. Given the aneurysm's location close to the proximal right bundle and left posterior fascicle, we believe that the cause for the aneurysm also injured both fascicles resulting in bifascicular block. The diagnosis of bifascicular block was confirmed using the electrocardiogram-derived vectorcardiography loops. These conduction abnormalities have remained stable. The case illustrates the utility of vectorcardiography in diagnosing bundle branch conduction defects. The case also illustrates the importance of anatomical considerations when encountering congenital heart defects., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2022, Nguyen et al.)

Abstract: Acute myocardial infarction is responsible for a significant proportion of morbidity and mortality in patients with ischaemic heart disease. Apart from cardiogenic shock, important mechanical complications include myocardial rupture, mitral regurgitation, mural thrombosis, left ventricular true aneurysm and pericarditis. Such patients are likely to be older (more than 60 years of age), especially women with hypertension, single-vessel disease, first episode of transmural infarction, smaller area of infarction, and/or delayed thrombolytic therapy. The incidences of all these complications have significantly reduced due to availability of reperfusion techniques. Myocardial rupture includes rupture of the left ventricular free wall, interventricular septum or papillary muscles, which can occur within few hours or days after infarction and emergency surgery is indicated. Lateral displacement of papillary muscles due to post-infarctional left ventricular remodelling is the main factor for ischaemic mitral regurgitation; some patients would require mitral valve repair or replacement. Mural thrombosis results from an abnormal flow and local hypercoagulable state and requires thrombolytic therapy or even surgical excision. Post-infarctional fibrosis is also responsible for formation of ventricular apical aneurysms and depending on the clinical status, reconstructional surgery may be required. Dressler''s syndrome is a rare occurrence of fibrinous pericarditis accompanied by constitutional symptoms, which responds to immunomodulation. [Copyright &y& Elsevier]

Abstract: The aim of the article is to gather and summarize the published data about the incidence, course of illness, treatment possibilities and complications of cardiovascular disorders in patients with mucopolysaccharidosis type VI (MPS VI) also known as Maroteaux–Lamy syndrome. MPS VI is a lysosomal storage disorder caused by deficient activity of N-acetylogalactosamine-4-sulfatase leading to progressive intracellular accumulation of glycosaminoglycans. The relatively low birth prevalence ranging from 1 in 43,000 to1 in 1.5 million births mirrors the limited descriptions of the cardiovascular disorders in the medical literature. Patients with MPS VI can be specifically treated with enzyme replacement therapy. Extra-cardiac features include growth retardation, coarse facial features, stiff joints, skeletal malformations (dysostosis multiplex), respiratory problems, corneal clouding, and hepatosplenomegaly. The clinical presentation varies considerably, however the development of heart disease and cardiac dysfunction is a serious problem in the majority of patients. The most characteristic cardiac presentation is valvular disease, while other MPS VI patients also develop cardiomyopathy, fibroelastosis, pulmonary hypertension, cardiac conduction system disorders and other complications. There are also reports on acute heart failure. Early cardiovascular manifestation may escape detection since joint stiffness or skeletal malformations limit maximal exercise levels and respiratory system involvement may mask the underlining cardiac insufficiency. A correct and timely diagnosis offers the possibility of disease-specific treatment leading to sustained clinical benefits for cardiac and non-cardiac MPS VI manifestations. [Copyright &y& Elsevier]

Abstract: A 46-year-old male was admitted to the emergency department after he was stabbed into the thorax. Initial diagnostics included immediate transthoracic two-dimensional echocardiography and multiphasic multidetector computed tomography of the thorax. The latter showed pericardial fluid during the early arterial phase and effusion of contrast medium into pericardium and pleural space during the late phase. The patient was transferred to the operation theatre for immediate pericardiotomy. Massive amounts of blood were evacuated and ventricular perforation was confirmed. It was not until the penetration was surgically closed via continuous suture that adequate cardiac rythym was re-established. The patient received intensive care and was extubated 2 weeks later. Repeated computed tomography of the chest revealed cardiac aneurysm as a typical complication to the injury sustained. The patient underwent a sophisticated rehabilitation program and was discharged in a satisfactory state. [Copyright &y& Elsevier]

Copyright of Clinical Research in Cardiology is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

A typical sequential course becomes apparent from the clinical features, the electrocardiography, echocardiography, radiological changes as well as angiographic results. This ultimately leads to an unusual complication of transmural myocardial infarction, i.e. the development of a pericardial pseudodiverticulum (less aptly described as pseudoaneurysm or false aneurysm). A timely cardiosurgical intervention may avert the otherwise fatal outcome. Copyright © 2004 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

Abstract: We reported four patients (2 to 10years) with Kawasaki disease complicated by clinically mild encephalitis/encephalopathy with a reversible splenial lesion (MERS). All were treated with γ-globulin (2 to 6g/kg) after the diagnosis of Kawasaki disease, the fever being alleviated between day 6 and 25. One of two patients exhibiting a poor response to γ-globulin had a cardiac aneurysm as a sequela. Their neurological manifestations (delirious behavior and drowsiness), laboratorial hyponatremia, and radiological abnormalities completely disappeared. It is important for pediatricians to acknowledge that MERS can be observed in patients with Kawasaki disease, especially in older children, and that they might be at high risk for cardiac abnormalities. [Copyright &y& Elsevier]

Introduction: Left ventricular aneurysm is a severe complication of acute myocardial infarction, which contributes significantly to mortality and morbidity associated with this pathology. Despite the progress of correction techniques, there are still controversies about the optimal approach addressing this pathology., Aim: The aim of this study was to analyse short and medium term outcomes of left ventricular reconstruction for ischemic left ventricular aneurysm using two surgical techniques (endoventricular patch plasty and liniar suture) in order to determine if one of these techniques has supperior results., Method: 117 patients were included in the study, 48 patients (41%) underwent left ventricular reconstruction with endoventricular patch (Group 1), 69 patients (59%; Group 2) had linear reconstruction. 113 patients (96.5%) required associated procedures: 108 surgical myocardial revascularization, 18 mitral valvuloplasty and 8 ventricular septal defect closure. Short and medium term morbidity, mortality, alteration of ejection fraction and NYHA class were analysed., Results: Perioperative mortality was 11.11%, 4.2% in the endoventricular patch group, and 15.9% in the linear suture group (p = 0.03). The overall 5-year survival was 78.5% (88.7% in Group 1 and 71.2% in Group 2). The left ventricular ejection fraction and NYHA functional class improved in both groups, with greater improvement in the endoventricular patch group., Conclusions: Surgical ventricular reconstruction is a procedure performed for the correction of ischemic left ventricular aneurysm with good early and medium-term results, but with better results with the endoventricular patch technique regarding early and medium-term mortality, ejection fraction and NYHA functional class improvement. Orv Hetil. 2018; 159(51): 2167-2174.