Spontaneous rupture of a false left ventricular aneurysm following myocardial infarction

Spontaneous rupture aneurysm following

of a false myocardial

left ventricular infarction

Kola~f .-1. Ersek, M.D. Elliot Chesler, M.A., M. R. C.P. (Edin.) Michael E. Kerns, M.D. Jesse E. Edwards, M.D.*

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upture of an aneurysm of the left ventricle is unconm~on. l\lycotic and ttxutnatic. aneurysms have a tendency to rupture’s? but rarely is this complication observed with the usual type of aneurysm of the left ventricle which is a sequel of tiig~ocat-dial ittfarction.3-5 This communication reports the findings in a case of healed myocardial infarction in which fatal hemopericardiurn resulted front rupture of a false aneurysm of the left ventricle. Case report IfXthout a past history of cardiac disease, a 73. year-old man complained of sudden onset of severe substernal pain which radiated to the jaw. The pain was persistent and was accompanied by shortness of breath and palpitations. Physical examination revealed an acutely ill patient whose blood pressure \vas 120 mm. Hg, systolic and 80 mm. Hg, diastolic. The pulse rate was 150 beats per minute and was irregular. There was no evidence of congestive cardiac failure. On admission, the roentgenograms of the thorax \vere normal apart from prominence of the ascending aorta; the electrocardiogram (ECG) revealed atrial fibrillation. This subsequently reverted spontaIKWI,SI~ to sinuh rhythm (Fig. 1). Abnormal Q waves

accompanied by elevation of the S-T segments were present in Lead aVF and standard Lead III. Abnvrmal Q waves were also present in standard Lead I I and Vg; the T waves were inverted in standard Leads II and III and in a\:F and V,. These findings were considered compatible with acute poiterolatcral m);ocardial infarction. The patient was treated with anticoagulalLts and sedatives. Ile died iuddenly on the second ho>pit;tl day. Pathalogicfentrrrcs. The pericardial sac was tigh tl> distended with blood and there were no adhesion> between the parietal pericardium and epicardium. The cause of the hemopericardium was a ruptured aneurysm situated on the posterior surface of the left ventricle near its apex. The aneurysm was oval and measured approximately 7 by 5 cm. in its greatest dimensions. A ragged perforation, approximatel) 2.5 cm. in length, was present on the anterior surface of the anew)-sm near its apex (Fig. ?,.,I ,~nd B). A transverse section through both ventricles .md the aneurysm showed an abrupt transition from the thick wall of the left ventricle to the thin wall of the aneurysm. The wall of the anew-l-sm W;IS onI}, 2 1nn1. thick and consisted of friable, gray, IibrouG tih-ue. The aneurysm was lined by laminated thronlbus except at the site of perforation (Fig. 3 1. The coronary arteries showed a severe degree oi atherosclerosis; an organizing thrombus was pre*ent in the proximal portion of the right co,-onar) arter) Histologically, bections from the junctiorl of the

the Department of ~‘athutog),, ‘l’he Charles T. Miller Hospital, St. Paul, 1Llinn.. and tb? Ikpartm’nts
I 7c~l. 77. !V;o. 5. pp. 677-680

May,

1969

Ancrican

Heart

Journal

d I’.itll(.r:lnt

iill)?.

677

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II’

Fig. 2. .-I, Exterior of the heart viewed from bulges po’tero-inferiorly. H, Exterior of the seen “head on.” The wall of the false aneurysm to espohe the thromhus within the aneur>.sm.

III

aVK

n left-anterior position. heart from inferoposterior of the left ventricle The site of perforation

aVL

aVF

False

aneurysm (F. 1 n.) of left ventricle view in which the false aneurysm has, in part, been dissected nwa~. (nrrow~ iy indicated by letter 1’.

is I

A

H

l;ig. 5. l’athogenesis of lesions observed illustrated diagrammatically. CL,:!cllte n1).ocnrdial infarction in the p<~y! b, Rupture of left ventricular wall in relation to acute myocardial infarct. (, Hemorrhage from ruptured hear-t contained within epicardium. Hematoma organizes to form fibrous ~~a11 of false anew)-sm. d, Iileeding fl-oni false aneurvsm into Dericardium. initiallv limited in amount, suddenly became massive to call- the onset of bleeding into the pericardium. Bleeding, which initially must have beeu of limited extent, suddenly became massive to result iu the massive hemopericardiunl (Fig. S,d) and the sudden death.

Summary a case of m~~ocardial iufarctioll, Ill rupture of the left ventricle resulted iu the formation of ;L false aneurysm. The aneurysm differed from that usually found in cases of m>~ocardial infarction in that its wall JV;LS formed crltirel>1)~ fibrous tissue. We wish to acknowledge the asistance of Drs. Kenneth B. Romness, Charles Carlson, and Rudolf I\‘. Kouclq.

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