JC46302

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1 1 Cardiac Rupture Caused by Myocardial Infarction in the Diagonal Branch Area: Evaluation by Cardiac Multislice Computed Tomography: A Case Report Nobuaki Kentaro Ken Masatoshi Naoyuki Yoshito Shigeru Tatsuro Susumu Keisuke Takaaki SUZUKI, MD MOTOYOSHI, MD KOZUMA, MD SUZUKI, MD YOKOYAMA, MD YAMAMOTO, MD SUZUKI, MD 1 KAMINAGA, MD 1 ISHIKAWA, MD 2 UEDA, MD 2 ISSHIKI, MD, FJCC Abstract A 75-year-old woman was admitted to the emergency room because of hypotension and loss of consciousness induced by cardiac tamponade. Electrocardiography revealed ST elevation and laboratory data showed elevation of serum creatine kinase and troponin I. The patient was referred to the cardiology department 5 days later. Cardiac catheterization revealed ventricular aneurysm in the anterior wall, significant stenosis 75% in the left anterior descending coronary artery and subtotal stenosis 99% in the diagonal branch. Cardiac multislice computed tomography suggested that the ventricular pseudoaneurysm was probably due to cardiac rupture caused by myocardial infarction in the diagonal area. Subsequently, aneurysmectomy and coronary artery bypass graft surgery were performed. Cardiac multislice computed tomography is useful for evaluating coronary artery and cardiac rupture. J Cardiol 2005 Aug ; 46 2 : Key Words Aneurysms pseudoaneurysm Computed tomography multislice Myocardial infarction, pathophysiology cardiac rupture 15% % 2 90% å 30 45% : Departments of Internal Medicine, 1 Radiology, and 2 Cardiovascular Surgery, Teikyo University, School of Medicine, Tokyo Address for correspondence : ISSHIKI T, MD, FJCC, Department of Internal Medicine, Teikyo University, School of Medicine, Kaga , Itabashi-ku, Tokyo ; isshiki@med.teikyo-u.ac.jp Manuscript November 16, 2004 ; revised January 11, 2005; accepted January 12,

2 72 Fig. 1 Electrocardiograms on admission and after drainage of the pericardium A : On admission. B: After drainage of the pericardium. 6 computed tomography: CTmultisector 7 8 CT 1 75 : å 140ml å 90/55mmHg CT ST I 5 : 141 cm 49.5 kg 122/78 mmhg 78/min : RBC / l Hb 10.4g/dl WBC 8,300/ l Plt / l AST 97IU/l ALT 66 IU/l LDH 282 IU/l CK 590IU/l CK- MB 92IU/l BUN 16.7 mg/dl Cr 0.86 mg/dl CRP 4.91mg/dl I ng/ml BNP 299 pg/ml X : 55% : a L STå

3 73 Fig. 2 Left ventriculograms Left: Systole. Right : Diastole. Fig. 3 Coronary arteriograms Arrowheads : 75% stenosis in the left anterior descending coronary artery and subtotal in the diagonal branch. Left: Right coronary artery. Right : Left coronary artery. ST 2 5 ST ST Fig. 1 : : CT Fig. 2 99% 75%

4 74 Fig. 4 Cardiac multislice computed tomograms Arrowheads: pseudoaneurysm. LA left atrium; LV left ventricle; RV right ventricle. Dor Fig. 5 Fig. 5 Surgical operation Arrowheads: pseudoaneurysm. LAD left anterior descending coronary artery ; PA pseudoaneurysm. Fig. 3CT Fig % CT CT al-saadon 9å

5 75 Frances % % 26% 6 CT 20 CT 75 STI 75% 99% J Cardiol 2005 Aug; 46 2 : Antman EM, Brawnwald E : Acute myocardial infarction. in Heart Disease: A Textbook of Cardiovascular Medicine ed by Braunwald E, Zipes DP, Libby P, 6th ed. WB Saunders, Philadelphia, 2001; pp Slater J, Brown RJ, Antonelli TA, Menon V, Boland J, Col J, Dzavik V, Greenberg M, Menegus M, Connery C, Hochman JS : Cardiogenic shock due to cardiac free-wall rupture or tamponade after acute myocardial infarction: A report from the SHOCK Trial Registry: Should we emergently revascularize occluded coronaries for cardiogenic shock? J Am Coll Cardiol 2000 ; 36: Vlodaver Z, Coe JI, Edwards JE: True and false left ventricular aneurysms : Propensity for the alter to rupture. Circulation 1975; 51: Davidson KH, Parisi AF, Harrington JJ, Barsamian EM, Fishbein MC : Pseudoaneurysm of the left ventricle : An unusual echocardiographic presentation: Review of the literature. Ann Intern Med 1977 ; 86 : Van Tassel RA, Edwards JE: Rupture of heart complicating myocardial infarction: Analysis of 40 cases including nine examples of left ventricular false aneurysm. Chest 1972; 61 : Frances C, Romero A, Grady D: Left ventricular pseudoaneurysm. J Am Coll Cardiol 1998; 32 : Kopp AF, Schroeder S, Kuettner A, Baumbach A, Georg C, Kuzo R, Heuschmid M, Ohnesorge B, Karsch KR, Claussen CD : Non-invasive coronary angiography with high resolution multidetector-row computed tomography: Results in 102 patients. Eur Heart J 2002; 23 : Juergens KU, Grude M, Maintz D, Fallenberg EM, Wichter T, Heindel W, Fischbach R : Multi-detector row CT of left ventricular function with dedicated analysis software versus MR imaging : Initial experience. Radiology 2004 ; 230 :

6 76 9 al-saadon K, Walley VM, Green M, Beanlands DS : Angiographic diagnosis of true and false LV aneurysms after inferior wall myocardial infarction. Cathet Cardiovasc Diagn 1995; 35: Gatewood RP Jr, Nanda NC: Differentiation of left ventricular pseudoaneurysm from true aneurysm with two dimensional echocardiography. Am J Cardiol 1980; 46 :

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