Cardiac Complications and Pseudoaneurysm Management

Cardiac pseudoaneurysm arises most often after transmural myocardial infarction, cardiac surgery or trauma when a myocardial rupture is contained by adherent pericardium or scar tissue rather than intact myocardium. This contained rupture lacks a full-thickness myocardial wall and is thus at high risk of sudden expansion or free-wall rupture. Clinically, patients may present with chest pain, dyspnoea, new murmurs or even signs of heart failure. Rapid and accurate differentiation from true aneurysm is essential, since true aneurysms involve all three layers of the ventricular wall, are less prone to rupture and may be managed electively. Diagnostic imaging has evolved to include two-dimensional and Doppler echocardiography as first-line tools, supplemented by contrast-enhanced computed tomography and cardiac magnetic resonance for detailed tissue characterisation and assessment of the aneurysmal neck. Treatment strategies hinge on prompt surgical repair for most pseudoaneurysms, often with patch closure techniques, whereas small, asymptomatic lesions in high-risk patients may occasionally be managed conservatively under strict surveillance. Advances in surgical access, including transatrial approaches, aim to minimise ventricular trauma, while refined perioperative support and multidisciplinary care have reduced morbidity and improved functional outcomes. Ongoing research focuses on refining risk stratification, enhancing imaging resolution and exploring less invasive closure devices to broaden therapeutic options worldwide.

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Cardiac Complications and Pseudoaneurysm Management publication trend

The graph below shows the total number of articles in cardiac complications and pseudoaneurysm management across all publications each year (not limited to Nature Index journals).

Technical terms

Left ventricular pseudoaneurysm: A ventricular outpouching resulting from myocardial rupture contained by pericardium or scar tissue without full-thickness myocardial wall.

True aneurysm: A ventricular bulge that involves intact endocardium, myocardium and epicardium, typically forming a broad-based neck and associated with lower rupture risk.

Echocardiography: An ultrasound-based imaging modality used to visualise cardiac structures, assess wall motion and detect flow abnormalities.

Transatrial repair: A surgical approach accessing a ventricular pseudoaneurysm via the left atrium to minimise direct ventricular trauma and facilitate simultaneous mitral valve procedures.

References

1. Left Ventricular Pseudoaneurysm: An Overview of Diagnosis and Management. Journal of Investigative Medicine High Impact Case Reports (2018).
2. Diagnosing left ventricular aneurysm from pseudo-aneurysm: a case report and a review in literature. Journal of Cardiothoracic Surgery (2009).
3. Surgical and Conservative Treatment of Post-infarction Left Ventricular Pseudoaneurysm. Frontiers in Cardiovascular Medicine (2022).
4. Cardiac Outpouchings: Definitions, Differential Diagnosis, and Therapeutic Approach. Cardiology Research and Practice (2021).
5. Transatrial repair of a giant left ventricular pseudoaneurysm and ischaemic mitral regurgitation after myocardial infarction: case report. European Heart Journal - Case Reports (2024).