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Eur Heart J Case Rep
Eur Heart J Case Rep
ehjcr
European Heart Journal. Case Reports
2514-2119
Oxford University Press UK

10.1093/ehjcr/ytae459
ytae459
Cardiovascular Flashlight
Cardiovascular Imaging
AcademicSubjects/MED00200
Eurheartj/31
Eurheartj/32
Eurheartj/35
Eurheartj/39
Eurheartj/41
Double chamber-like left ventricle
https://orcid.org/0000-0003-4418-7834
Shiba Mikio Cardiovascular Division, Osaka Police Hospital, 10-31 Kitayama-cho, Tennoji-ku, Osaka 543-0035, Japan

https://orcid.org/0000-0002-1665-3407
Higuchi Yoshiharu Cardiovascular Division, Osaka Police Hospital, 10-31 Kitayama-cho, Tennoji-ku, Osaka 543-0035, Japan

Monzo Luca Handling Editor
Corresponding author. Tel: +81 6 6771 6051, Fax: +81 6 6775 2838, Email: yhiguchi.ja@gmail.com
Conflict of interest: None declared.

9 2024
27 8 2024
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© The Author(s) 2024. Published by Oxford University Press on behalf of the European Society of Cardiology.
2024
https://creativecommons.org/licenses/by/4.0/ This is an Open Access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted reuse, distribution, and reproduction in any medium, provided the original work is properly cited.
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An 89-year-old woman who had undergone surgical aortic valve replacement 25 years ago was admitted to our hospital with deficient articulation and diagnosed with a cerebrovascular accident. An echocardiogram revealed what appeared to be a ventricular aneurysm (Panel A and see Supplementary material online, Movie S1), with a to-and-fro flow observed between it and the left ventricle (Panel B and see Supplementary material online, Movie S2). A contrast-enhanced thoracic computed tomography (CT) scan indicated a left ventricular aneurysm 90 mm in diameter, with a mural thrombus that was very thin and stratified (Panels C and D). On history taking, it was revealed that 4 months ago, she had received conservative treatment for a ventricular rupture secondary to acute myocardial infarction due to the occlusion of the right coronary artery. The aneurysmal structure was surgically resected (Panel E), and the heart was repaired with a bovine pericardial patch. Histological examination led to a diagnosis of a pseudoaneurysm (Panel F).

The patient was discharged without complications after a month of hospital stay. Pericardial adhesions resulting from her previous open-heart surgery may have provided structural support, preventing rupture and allowing the pseudoaneurysm to enlarge over time. Thrombus formation in a pseudoaneurysm is one of the causes of embolic stroke. In addition to imaging diagnostics, such as echocardiography and CT, a detailed medical history provides key insights into the mechanism of anatomical deformation and subsequent thrombus formation.

Supplementary Material

ytae459_Supplementary_Data

Acknowledgements

The authors thank Drs Naoya Muraoka and Masatoshi Hata (Osaka Police Hospital, Osaka, Japan) for their clinical management and Drs Themistoklis Katsimichas (Hippokration Hospital, Athens, Greece) and Yoshihiko Ikeda (National Cerebral and Cardiovascular Center, Osaka, Japan) for excellent advice.

Consent: The authors confirm that they have obtained written informed consent from the patient for the submission and publication of this report, including images and associated text, in accordance with COPE guidelines.

Funding: None declared.

Supplementary material

Supplementary material is available at European Heart Journal – Case Reports online.

Data availability

The data underlying this article will be shared upon reasonable request to the corresponding author.
