Normal and anomalous coronary arteries: definitions and classification.

Ventricular septal and free wall rupture complicating acute myocardial infarction: experience in the Multicenter Investigation of Limitation of Infarct Size.

Real time two dimensional echocardiographic findings in four patients with a pathologically proved left ventricular pseudoaneurysm were compared with those in seven patients with a similarly proved true aneurysm of the left ventricle. Pseudoaneurysms produced a bounded echo-free space with a narrow neck that communicated with the left ventricular cavity. The maximal internal width of this neck (O max ) was much smaller than the maximal parallel internal diameter (D max ) of the aneurysmal sac, and the ratio O max /D max never exceeded 0.5. In all cases the pseudoaneurysm could be seen extending behind the intact portion of the involved left ventricular wall, and this finding produced a characteristic beak-like configuration in the studies of two patients. In contrast, true aneurysm resulted in local bulging and dilatation of the left ventricular wall so that the maximal internal width of the mouth (O max ) was nearly equal to, or actually represented, the maximal internal diameter (D max ) of the aneurysm so that the ratio O max /D max ranged from 0.9 to 1.0. Our preliminary study indicates that real time two dimensional echocardiography is useful in differentiating pseudoaneurysm from true aneurysm of the left ventricle.

Differentiation of left ventricular pseudoaneurysm from true aneurysm with two dimensional echocardiography

A congenital left ventricular aneurysm or diverticulum is a rare cardiac malformation; 411 cases have been reported since its first description in 1816, and other cardiac, vascular or thoraco-abdominal abnormalities have been shown in about 70%. It appears to be a developmental anomaly, starting in the 4th embryonic week. Diagnosis can be made after exclusion of coronary artery disease, local or systemic inflammation or traumatic causes as well as cardiomyopathies. Clinically, most congenital left ventricular aneurysms and diverticula are asymptomatic or may cause systemic embolization, heart failure, valvular regurgitation, ventricular wall rupture, ventricular tachycardia or sudden cardiac death. Diagnosis is established by imaging studies such as echocardiography, magnetic resonance imaging or left ventricular angiography, visualizing the structural changes and accompanying abnormalities. Mode of treatment has to be individually tailored and depends on clinical presentation, accompanying abnormalities and possible complications; treatment options include surgical resection especially in symptomatic patients, anticoagulation after systemic embolization, radiofrequency ablation or implantation of an implantable cardioverter defibrillator in case of symptomatic ventricular tachycardia, occasionally combined with class I or III antiarrhythmic drugs.

Congenital Left Ventricular Aneurysms and Diverticula: Definition, Pathophysiology, Clinical Relevance and Treatment

Surgical treatment for infarct-related ventricular septal defects. Improved early results combined with analysis of late functional status.

Two cases of abnormalities in development of the left ventricular wall (left ventricular aneurysm or diverticulum) are presented. In 1 case the defect was an isolated finding in an otherwise asymptomatic child. In the second, the malformation was associated with midline thoracoabdominal defects in a middle-aged man. Both patients had the diagnosis confirmed by cardiac catheterization and angiography and underwent successful surgical correction of the abnormality. The clinical, angiographic and pathologic characteristics of congenital diverticulum and aneurysm of the heart are reviewed, and an attempt is made to clarify the concept of congenital aneurysm and diverticulum of the heart.

Diverticulum or aneurysm of left ventricle.

A 64-year-old man with chronic atrial fibrillation was referred to our hospital for resection of a biopsy-proven adenocarcinoma of the right lung. A preoperative coronary angiogram demonstrated large, tortuous collateral vessels arising from the proximal right (Figure 1) and left circumflex (Figure 2 …

Absent Right Pulmonary Artery With Coronary Collaterals Supplying the Affected Lung

A 43-yr-old man with mild, fixed obstruction of the left anterior descending (LAD) coronary artery and severe, uncontrolled variant angina underwent placement of an endovascular stent to preserve patency of the artery. The decision for stent placement was based on several factors, including refractoriness to medical treatment and standard balloon angioplasty, documented spasm localized to the proximal LAD lesion, and the morbidity, mortality, and costs associated with the surgical approach in this type of patient. At follow-up, there was moderate restenosis of the stented coronary segment; the vasospastic angina syndrome had totally resolved.

Gianturco-Roubin stent placement for variant angina refractory to medical treatment.

The association of tetralogy of Fallot with supravalvular mitral stenosis is a rare anomaly that has been reported only once previously The difficulty of preoperative diagnosis is emphasized Although left-sided obstructive lesions in association with tetralogy of Fallot are rare, their recognition is imperative since these are surgically correctable anomalies and potentially lethal, as proved in this case and the one previously reported

Roberto Lufschanowski

Papers

Diverticulum or aneurysm of left ventricle.

Absent Right Pulmonary Artery With Coronary Collaterals Supplying the Affected Lung

Gianturco-Roubin stent placement for variant angina refractory to medical treatment.

Supravalvular mitral stenosis associated with tetralogy of Fallot

Ventricular Septal Rupture, Secondary to Myocardial Infarction