2025/02/15 by Yue-Li Wang, Hongkai Zhang, Rongjuan Li +1 · 1 voice
Medicine · #Cardiac Structural Anomalies and Repair #Cardiac Valve Diseases and Treatments #Pericarditis and Cardiac Tamponade
paper · doi:10.1093/ehjci/jeaf058
openalex publication_date 2025/02/15 · openalex created_date 2025/10/10 · openalex updated_date 2026/07/29
A 53-year-old male presented with a 10-day history of chest pain without any prior history of chronic diseases such as hypertension, diabetes, or coronary heart disease. Upon admission, emergency bedside echocardiography (parasternal long-axis view) revealed a left atrial (LA) false lumen formed by a membranous structure (Panels A and B), which was attributed to the lesion in the basal segment of the left ventricular (LV) inferior wall, where the myocardial rupture, demonstrating suspected ventricular aneurysm. Colour Doppler imaging indicated LV blood flow entering the inferior wall rupture, subsequently traversing the tunnel fashioned by the torn myocardial tissue into the LA false lumen, and passing through a small residual foramen ovale(*) to reach the right atrium (Panels C–E and Supplementary data online, Videos S1–S4). Mild pericardial effusion and mitral regurgitation were also observed. Coronary angiography revealed severe stenosis of the middle and distal right coronary arteries. Cardiac magnetic resonance imaging demonstrated pseudoaneurysm in the basal segment of the LV inferior wall, with myocardial tissue tearing, forming an irregular tunnel extending to the LA wall (Panels H and I; Supplementary data online, Videos S5–S7; Appendix-Image). The diagnosis was LV pseudoaneurysm/myocardial rupture from the inferior wall to the left atrium. Intraoperative findings confirmed the preoperative diagnosis. Myocardial repair was performed using bovine pericardial patch, and coronary artery bypass grafting was performed. The patient’s postoperative course was uneventful. LA extension of inferior myocardial rupture secondary to myocardial infarction is uncommon, and multimodal imaging is beneficial for preoperative evaluation.