Ventricular Aneurysms

  

·        Congenital left ventricular aneurysms

o       Rare

o       Young black adults

o       Produce abnormal bulge in region of left atrium or

o       Cardiac enlargement from aortic insufficiency

o       Acquired left ventricular aneurysms

§         Usually complication of myocardial infarction

§         May be associated with

·        Persistent congestive heart failure

·        Arrythmias

·        Peripheral embolization

§         Usually are either true or false aneurysms

·        True ventricular aneurysms

o       Localized outpouching of ventricular cavity

§         Associated with dyskinesia

§         Wide-mouthed in connection with the LV

o       Anterolateral or apical wall

o       Frequently not visible on chest x-ray but may produce localized bulge of left heart border

o       Paradoxical expansion during systole

o       May have rim of calcium in fibrotic wall

o       Ventriculography is diagnostic

§         Complications

·        Thrombus with embolization

·        Rarely rupture

 

·        False or pseudoaneurysms

o       False aneurysm occurs when left ventricle ruptures into pericardial sac

§         Pericardial adhesions contain rupture

o       Usually occurs on posterolateral wall

o       Diameter of mouth is smaller

 

 

Enhanced CT scan at level of heart shows

large left ventricular aneurysm partially filled with clot

 

o       Causes

§         Myocardial infarction

§         Trauma

o       Increase in size over serial films suggests false aneurysm

§         This finding indicates the patient requires immediate attention

o       High risk of delayed rupture

·        Calcification of left ventricular wall takes several years after myocardial infarction