Discussion
Postinfarction pseudoaneurysm is defined as an ischemic myocardial rupture contained by the pericardium. Although the incidence of postinfarction pseudoaneurysms is decreasing due to early coronary revascularization, it remains a serious complication of myocardial infarction. Most patients with pseudoaneurysms are asymptomatic. However, pseudoaneurysm-associated complications including heart failure, arrhythmia, systemic embolism and rupture are catastrophic with high mortality. Prompt diagnosis and urgent repair are mandatory to prevent further complications (1-3).
The goal of repair is to restore left ventricular geometry and improve function. Surgical repair has been the cornerstone therapy option for the treatment of postinfarction pseudoaneurysm. The endoventricular circular patch plasty, also known as the ‘Dor technique’, is the preferred surgical strategy in exclusion of left ventricular pseudoaneurysms, especially for pseudoaneurysms with large neck (4-5). In patients with previous cardiac surgery, transaortic or transmitral access can be an alternative approach. The latter strategy offers several advantages, including hemostatic repair without resection of the pseudoaneurysm and no risk of myocardial damage in cases with adhesions or coronary artery bypass grafts (6).
In high-risk patients for surgery, transcatheter pseudoaneurysm closure is an alternative strategy in selected cases. Cliff et al described the first successful transcatheter pseudoaneurysm closure in 2004 using a septal occluder (7). A small retrospective study including patients demonstrated the feasibility and safety of this approach. Preoperative imaging and patient tailored approach are the cornerstones of best outcome (8).
REFRENCES
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