PDF(Pubmed)
Abstract：
This case report delineates the clinical trajectory and management strategies of a 59-year-old Hispanic male diagnosed with a left ventricular pseudoaneurysm (LVPA) following a delayed presentation of ST-segment elevation myocardial infarction (STEMI), for which reperfusion treatment was not administered. Initially, an echocardiogram demonstrated an extensive anterolateral myocardial infarction, severe left ventricular systolic dysfunction, and an early-stage left ventricular apical aneurysm with thrombus, leading to the initiation of warfarin. Metabolic myocardial perfusion imaging via positron emission tomography indicated a substantial myocardial scar without viability, guiding the decision against revascularization. Post discharge, the patient, equipped with a wearable cardioverter defibrillator for sudden cardiac death prevention, experienced symptomatic ventricular tachycardia, which was resolved with defibrillator shocks. Subsequent imaging revealed an acute LVPA adjacent to the existing left ventricular aneurysm. Given the high surgical risk, conservative management was elected, resulting in thrombosis and closure of the pseudoaneurysm after two weeks. The patient eventually transitioned to home hospice, surviving an additional five months. This report underscores the complexities and therapeutic dilemmas in managing post-MI LVPA patients who are ineligible for surgical intervention.
摘要：
该病例报告描述了一名59岁的西班牙裔男性在延迟出现ST段抬高型心肌梗死（STEMI）后诊断为左心室假性动脉瘤（LVPA）的临床轨迹和管理策略。未进行再灌注治疗。最初，超声心动图显示广泛的前外侧心肌梗死，严重的左心室收缩功能障碍,早期左心室心尖部动脉瘤伴血栓,导致华法林的开始。通过正电子发射断层扫描进行的代谢心肌灌注成像表明有大量的心肌瘢痕，没有生存力。指导反对血运重建的决定。放电后,病人,配备了可穿戴的心律转复除颤器，用于预防心源性猝死，有症状的室性心动过速,通过除颤器电击解决了。随后的成像显示与现有的左心室动脉瘤相邻的急性LVPA。鉴于手术风险高,保守的管理层当选，两周后导致假性动脉瘤的血栓形成和闭合。病人最终过渡到家庭收容所，再存活五个月。该报告强调了管理不适合手术干预的MI后LVPA患者的复杂性和治疗困境。
