Post infarction pseudoaneurysm: Clinical and echocardiographic features in 22 cases

Background : Cardiac pseudoaneurysm (Ps) is an uncommon but frequently fatal complication of acute myocardial infarction. Objective : To review the clinical and echocardiographic features of patients with postinfarction Ps Design : Retrospective analysis of patients with postinfarction Ps seen at the Mayo Clinic between 1980 and 1996. Results : Twenty-two patients (17, 77% males, mean age= 68±10 years) with postinfarction Ps were identified. Ps was discovered incidentally in 5 (23%) patients who were asymptomalic. Four (18%) patients presented acutely, 3 as acute myocardial infarction and 1 in cardiac tamponade. Other clinical presentations included congestive heart failure in 3 (14%), chest pain in 3 (14%), syncope/arrhythmia in 4(18.2%) and systemic embolism in 3 (14%). The locations of the Ps were:inferior in 11, inferolateral in 7 and anterior in 4. Two-dimensional Doppler echocardiography was the diagnostic method used in 17 patients. Thrombus in the Ps cavity was seen in 5 patients. The ratio of maximal internal width of the communicating orifice to the maximal parallel diameter of the Ps cavity, O_max/D_max, was 0.45± 0.24, and was < 0.5 (previously defined as narrow neck) in 10 (63%) patients. Row in and out of the Ps cavity was detected on Doppler color flow imaging in all 17 patients who had an echocardiographic examination.Sixteen (73%) patients underwent surgical repair with an overall operative mortality of 12.5%. Six (27%) patients did not have surgery. After a median follow-up of 3.6 years, fourteen (64%) patients died (9 in surgical and 5 in medical group): 8 from non-cardiac causes, 3 from congestive heart failure and another 3 from recurrent myocardial infarction. There was no documented cardiac rupture. Total and cardiac mortality were not statistically different between the two treatment groups. Conclusions : 1). Two-dimensional Doppler echocardiography is useful in diagnosing this condition. Contrary to previous beliefs, a significant number of Ps have a wide neck. 2).Surgical repair has an acceptable operative mortality. 3).Cardiac rupture was uncommon in patients treated medically, and most deaths were related to underlying ischemic heart disease or associated medical conditions.