Emmert, Maximilian Y.

Falk, Volkmar

Frauenfelder, Thomas

Hoerstrup, Simon P.

Weber, Benedikt

Wilhelm, Markus J.

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CARDIOVASCULAR FLASHLIGHT. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .doi:10.1093/eurheartj/ehr078Online publish-ahead-of-print 29 March 2011Impressive left ventricular pseudoaneurysm mimicking a pericardialtamponade 5 years after mitral valve replacement for endocarditisMaximilian Y. Emmert1*, Markus J. Wilhelm1, Thomas Frauenfelder2, BenediktWeber1,Simon P. Hoerstrup1, and Volkmar Falk11Clinic for Cardiovascular Surgery, University Hospital Zurich, Raemi Street 100, 8091 Zurich, Switzerland and 2Department for Diagnostic Radiology, University HospitalZurich, Zurich, Switzerland* Corresponding author. Tel: +41 442553298, Fax: +41 442554446, Email: maximilian.emmert@usz.chThis paper was guest edited by Prof. Frank E. Rademakers, University Hospital Gasthuisberg, Leuven, BelgiumA 66-year-old female patient with a history of mechanical mitral valvereplacement (MVR) due to endocarditis 5 years ago was referredwith shortness of breath, tachycardia, and beginning hypotension. Inaddition, the patient appeared to have prominent jugular veinssuggesting a pericardial tamponade. Transthoracic echocardiography(TTE) displayed a partly calcified pericardial effusion (13 × 8 cm) com-pressing the right ventricle (RV) and the right atrium (RA) (Panel A), andcomputed tomography revealed a giant left ventricular pseudoaneurysm(LVPA) (10 × 10 cm) originating from the posterior mitral valve annulus(Panel B, white arrow). The impressive LVPA compressing the RV, theRA, and the inferior vena cava (Panels C and D; see SupplementaryVideo 1) was perfused through a tunnel-like structure (Panel E, blackarrow; see Supplementary Video 2) that communicated with the leftventricular posterolateral wall below the prosthetic mitral valve. TheLVPA was partially resected and a 4 × 4 cm atrioventricular dehiscencebecame apparent (Panel F, black arrow) which was repaired from theinside of the left atrium using a 4 × 4 cm patch, before re-replacementof the mechanical valve (MVR) was performed. The procedure wasuneventful and the patient made a swift recovery. Here, we present avery impressive image and motion series of a giant LVPA originatingfrom below the mitral annulus 5 years after mechanical MVR. Left ven-tricular pseudoaneurysm is a rare condition that is difficult to diagnose(Miura et al., Ann Thorac Surg 2008;85:643–645). Although myocardialinfarction is the most common reason for LVPA (Amasyali et al., Int JCardiol 2007;119:e51–e5), one-third result from surgical procedures, most often after MVR (Frances et al., J Am Coll Cardiol1998;32:557–561). Therefore, regular follow-up including TTE is mandatory after MVR.Figure. RV, right ventricle; RA, right atrium; AA, ascending aorta; LVPA, left ventricular pseudoaneurysm.Supplementary materialSupplementary material is available at European Heart Journal online.Published on behalf of the European Society of Cardiology. All rights reserved. & The Author 2011. For permissions please email: journals.permissions@oup.com.Cardiovascular flashlight1820

Impressive left ventricular pseudoaneurysm mimicking a pericardial tamponade 5 years after mitral valve replacement for endocarditis

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