Post-infarction Ventricular Aneurysms

Abstract

Both true and false aneurysms of the heart are complications of myocardial infarction. A true aneurysm results from gradual thinning of the portion of the ventricular wall after transmural infarction. False aneurysms also termed pseudoaneurysms occur after hemorrhagic dissection into an area of transmural infarction and most commonly result in free intrapericardial rupture of the heart, cardiac tamponade, and death. Rarely, if the overlying pericardium becomes adherent to the epicardium along the surface of the infarct, it can contain the rupture. This then becomes a false aneurysm, its wall being lined by pericardium and mural thrombus. The distinction between true and pseudo aneurysm is diagnostically challenging. Both types of aneurysms can cause symptoms, including chest pain, shortness of breath, and syncope, but most often are incidentally noted on cardiac imaging ordered for other purposes. When a post-infarction left ventricular aneurysm is identified, it is important to distinguish accurately between a pseudoaneurysm and true aneurysm given the differing natural history and therapeutic strategies. This chapter deals with the pathogenesis, pathophysiology and management of post-infarction true and false aneurysms of left ventricle.