Pseudoaneurysm of the left ventricle in the presence of Dressler's syndrome.
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ABSTRACT:
SUBMITTER: Dobrilovic N
PROVIDER: S-EPMC1894725 | biostudies-literature | 2007
REPOSITORIES: biostudies-literature
Publications
Pseudoaneurysm of the left ventricle in the presence of Dressler's syndrome.
Dobrilovic Nikola N Passik Cary S CS Shaw Richard R
Texas Heart Institute journal 20070101 2
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Project description:BackgroundPseudoaneurysm (PSA) of the left ventricle (LV) is a rare peri-annular complication of infective endocarditis (IE), and it is associated with high risk of free wall rupture. The diagnosis is challenging because the exact incidence and the pathogenesis are still unclear.Case summaryA 69-year-old lady underwent prosthetic mitral valve replacement for IE secondary to Staphylococcus aureus sepsis complicated by multiple embolizations. In the post-operative period, the patient developed persistent low-grade fever with negative blood culture. Transoesophageal echocardiography (TOE) revealed complete posterior valve detachment and a PSA sac arising from the antero-lateral commissure; the colour flow Doppler showed massive mitral regurgitation. Thoracic computed tomography (CT) scan confirmed the echo data and the exact localization of the cardiac rupture. The patient underwent reoperation, a pericardial patch was sutured to exclude the PSA sac, and a mechanical prosthesis valve was finally implanted. A follow-up TOE revealed the exclusion of the PSA; two leakages with mild peri-valvular mitral regurgitation were found, with no haemodynamic impact.DiscussionIn our case, the patient developed a PSA of the LV as a consequence of peri-annular extension of IE on the mitral valve. Pseudoaneurysm is a potentially lethal complication, if not promptly treated. Multimodality imaging including echocardiography and CT scan is recommended, in order to plan surgery ad hoc.
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