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vol. 16
Letter to the Editor

Percutaneous left ventricular pseudoaneurysm closure

Tomas Hnat
Radka Adlova
Jiri Fiedler
Josef Veselka

Department of Cardiology, 2nd Medical School, Charles University, University Hospital Motol and 2nd Medical School, Charles University, Prague
Arch Med Sci 2020; 16 (5): 1247–1249
Online publish date: 2020/04/08
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Left ventricular pseudoaneurysm (LVPSA) is a rare complication following myocardial infarction, cardiac surgery, infection, and chest trauma, and recently it has also been described as a complication of a trans­apical access site for cardiac procedures (such as transapical aortic valve replacement [1] or transapical mitral valve procedures). It is caused by a free wall rupture contained by an adherent pericardium, not leading to an immediate hemopericardium and cardiac tamponade. However, the risk of a fatal rupture remains high. Frances et al. [2] reported mortality rates up to 30–45% when treated conservatively and even though more recent studies [3, 4] show better long-term outcome even if LVPSA is left untreated, surgical repair has historically been preferred. Given the fact that many patients undergoing cardiac procedures are at high risk considering surgery or reoperation, percutaneous approaches to closure of LVPSA have recently been described [5]. We present our experience with transfemoral closure of a posterobasal left ventricular pseudoaneurysm using the atrial septal defect (ASD) occluder.
In October 2016, a 70-year-old female patient with infectious mitral valve endocarditis complicated by severe mitral regurgitation due to posterior leaflet perforation and perforation of a paravalvular abscess underwent cardiac surgery consisting of mitral valve replacement using an SJM Epic 25 mm bioprosthesis and repair of the left ventricle and left atrium using a bovine pericardium. She recovered well and was transferred to a local hospital for subsequent antibiotic treatment. A month after the surgical treatment the patient was admitted to our department with acute worsening of exertional dyspnea and progressive heart failure.
Transesophageal echocardiography revealed 3/4 paravalvular mitral regurgitation and a 36 × 39 mm posterobasal left ventricular pseudo­aneurysm (Figure 1 A) with 2 separate leaks just under the mitral bioprosthesis. Contrast-enhanced computed tomography angiography of the heart confirmed 57 × 33 × 35 mm LVPSA (Figure 1 B) that was deviating the patient’s circumflex artery. The diameter of the wider neck of the LVPSA was 7 mm. Coronary catheterization and angiography of the left ventricle (LV) were performed afterwards, revealing a dynamic obstruction of the left marginal artery by the LVPSA. Consequently, a cardiovascular surgeon was consulted and the surgical closure was contraindicated because of high...

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