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Innovations: Technology & Techniques in Cardiothoracic & Vascular Surgery:
doi: 10.1097/IMI.0b013e3181b01c36
Pictorial Essays

Left Ventricular Pseudoaneurysm Demonstrated by 64-Multislice Computed Tomography

Jebelli, Mohammad MD*; Kernstine, Kemp MD, PhD†; Mandegar, Mohammad Hossein MD*; Chitsaz, Sam MD*; Rayatzadeh, Hussein MD*

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From the *Department of Cardiovascular Surgery, Shariati Hospital, Medical Sciences, University of Tehran, Tehran, Iran; and †Division of Thoracic Surgery, City of Hope Medical Center and Beckman Research Institute, Duarte, CA, USA.

Accepted for publication May 14, 2009.

Address correspondence and reprints requests to Hussein Rayatzadeh, MD, Department of Cardiovascular Surgery, Shariati Hospital, North Kargar Avenue, Jalal Al-Ahmad Street, PO Box: 14114, Tehran, Iran. E-mail: hrayatzadeh@yahoo.com.

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Abstract

A 50-year-old man with a history of left ventricular aneurysmectomy was evaluated with a 64-multislice computed tomogram, which demonstrated left ventricular enlargement and a pseudoaneurysm at the apicolateral side. The images were critical to our management. We resected the pseudoaneurysm with an excellent outcome.

The 64-slice multislice computed tomogram of a left ventricular (LV) pseudoaneurysm proved to be a valuable management tool for our patient, a 50-year-old man with a history of a primary LV aneurysmectomy and a single-vessel coronary artery bypass grafting, 4 years previously. He had been lost to follow-up and had continued his postoperative warfarin. Because of this and in spite of the patient being symptom-free, we chose to perform a transthoracic echocardiogram. It demonstrated a potential apico-lateral LV pseudoaneurysm (58×41 mm) with mural thrombus and 5 to 6 mm orifice connection to LV. The saphenous vein graft demonstrated flow. The warfarin was discontinued. Two months later re-evaluation by transesophageal echocardiogram was performed. There was no difference in the size or the character of the pseudoaneurysm. To better understand the three-dimensional aspect of the pseudoaneurysm, a multislice computed tomogram was performed and demonstrated the precise location and size of the pseudoaneurysm (Figs. 1, 2). The patient underwent reoperation and the pseudoaneurysm was resected. Discharge was on the fifth postoperative day.

Figure 1
Figure 1
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Figure 2
Figure 2
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Keywords:

Pseudoaneurysm; 64-multislice computed tomography

© 2009 Lippincott Williams & Wilkins, Inc.

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