Scintigraphic assessment of false left ventricular aneurysms

After myocardial infarction, patients may develop congestive heart failure, arrhythmias, or peripheral emboli due to true or false left ventricular aneurysms. False ventricular aneurysms differ from true aneurysms in that has been rupture of the left ventricular myocardium into the pericardium without rupture of the pericardial sac. The diagnosis of false aneurysm is particularly important because, in addition to the problems cited, there is a high incidence of rupture that may be prevented with surgical intervention. Four patients presenting with congestive heart failure and studied by gated cardiac blood pool scintigraphy were shown to have false left ventricular aneurysms and confirmed angiographically or surgically. Technetium-99m-gated cardiac blood pool scintiscans demonstrated discrete paraventricular chambers usually posterior in position with marrow necked connections to the left ventricle. Thallium-201 rest myocardial perfusion scintiscans performed in two of the four patients demonstrated a defect corresponding to the neck of the false aneurysm in one patient and a larger defect in the second patient with both a true and false aneurysm. It was concluded that combined gated cardiac blood pool scintigraphy and 201Tl myocardial scintigraphy provide a noninvasive method for diagnosing false left ventricular aneurysms.