Right Ventricular Free Wall Pseudoaneurysm Following an Inferior Myocardial Reinfarction Cured by Late Mechanical Reperfusion

摘要

We present a 63-year male patient with an inferior-wall myocardial reinfarction and a recent episode of gastrointerstinal bleeding, who was treated with mechanical reperfusion sixteen hours after the onset of pain, and who experienced right ventricular pseudoaneurism as a serious postinfarction mechanical complication. Elective surgical revascularisation was the definite treatment. Introduction In-hospital reccurent acute myocardial infarction (AMI) is associated with an inverse prognosis, primarily because of an increase in early mortality during the index hospitalization 1. Revascularization during the index hospital period, even out to 36 hours post MI 2, is associated with a lower rate of early and long-term mortality up to two years. Mechanical complications after AMI strongly influence the prognosis. There are very few reported cases of right ventricular (RV) free wall pseudoaneurysm after AMI, resembling the wall rupture contained into the myopericardial space 3. Because of a high risk of rupture, prophylactic repair of this serious complication is indicated soon after an exact echocardiographic diagnosis is assessed 4. Case Report A 63-year male patient was admitted into the coronary care unit because of precordial pain lasting for 2 hours before presentation. He suffered several attacks of gastrointestinal bleeding since 1961 when duodenal ulcer was diagnosed; the last attack occurred eight days before admission. His physical presentation was normal. The electrocardiogram (ECG) showed atrial fibrillation, monomorphic ventricular premature beats, ST segment elevation in leads II, III, aVF and V4R-V6R, and ST segment depression in leads I, aVL, V2-V6.The diagnosis of acute inferoposterior myocardial reinfarction was established, and a parenteral therapy with analgetics, H2 blockers, and anticoagulants was started. Twenty-four hours after admission, the patient was painless. Unfortunately, on the fourth day of hospitalization he experienced intensive retrosternal pain, and ECG showed nodal rhythm (Figure 1).