Subepicardial Aneurysm That Was Diagnosed by Cardiac Imaging and Underwent Successful Surgery

• DOI: 10.1161/circulationaha.115.018427
• Publication Date: 2015-09-21T20:23:05Z
• Authors: Ying Zheng; Jing Ping Sun; Xuedong Shen; Zhiqing Qiao; Heng Ge; Zheng Li; Ben He; Cheuk-Man Yu
• Keywords: Male; Cardiovascular Surgical Procedures; Myocardial Infarction; Aneurysm, Ruptured; Middle Aged; Magnetic Resonance Imaging; Cardiac Imaging Techniques; Electrocardiography; 03 medical and health sciences; Treatment Outcome; 0302 clinical medicine; Echocardiography; Risk Factors; Humans; Heart Aneurysm; Pericardium

A 63-year-old man was admitted because of current chest pain with perspiration for 6 hours. Electrocardiography showed complete right bundle-branch block and ST-segment elevation on leads II, III, aVF, and V2 through V6 (Figure 1); we therefore suspected an anterior and inferior wall acute myocardial infarction. Coronary angiography revealed total occlusion of the proximal left anterior descending artery (Figure 2 and Movie I in the online-only Data Supplement); the left circumflex and right coronary arteries showed no abnormalities. The left anterior descending artery was recanalized by percutaneous catheter intervention. The patient complained of chest pain the next afternoon after percutaneous catheter intervention, and the ECG was not changed. A transthoracic echocardiogram was performed, which demonstrated that the apical segments of the left ventricular walls were akinetic with normal thickness in the 4-chamber view (Movie II in the online-only Data Supplement), but the apex myocardium was dyskinetic with a perforation (2 mm in diameter) connected to a small apical aneurysm (10×5 mm) covered by intact epicardium that communicated with the left ventricular cavity as demonstrated by color Doppler (Figure 3A and 3B and Movie III in the online-only Data Supplement) from the apical 2-chamber view. This was consistent with a subepicardial aneurysm (SEA). On the follow-up echocardiography performed 8 days after infarction, …