Key result
A young female with systemic lupus erythematosus developed a contained myocardial rupture and left ventricular pseudoaneurysm in the absence of coronary artery disease, which was successfully repaired.
Why the study?
Systemic erythematous lupus is associated with significant cardiovascular morbidity and mortality even in young patients, with myocardial rupture and pseudoaneurysm being rare complications.
Case Report (n=1)
Myocardial rupture with LV pseudoaneurysm can rarely occur in the setting of SLE-associated myocarditis, requiring early diagnosis and urgent surgical intervention.
BACKGROUND: Systemic erythematous lupus (SLE) is an autoimmune disease associated with significant cardiovascular morbidity and mortality, even in young patients. CASE SUMMARY: A young female with recently diagnosed SLE under corticotherapy developed pulmonary oedema and respiratory failure. The diagnostic workup revealed mildly elevated cardiac troponin, significantly elevated NT-proB-type natriuretic peptide (NT-proBNP) and mild pericardial effusion without other echocardiographic abnormalities. Systemic erythematous lupus-associated myocarditis was presumed, and her clinical status improved after corticotherapy intensification. However, transthoracic echocardiogram repeated days later revealed a large pericardial effusion with findings suggestive of a contained myocardial rupture originating in the inferolateral basal left ventricular (LV) segment, which was confirmed by computed tomography scan. Cardiac catheterization exhibited normal coronary arteries. The patient was submitted to cardiac surgery and the LV pseudoaneurysm was successfully repaired. DISCUSSION: Myocardial rupture with LV pseudoaneurysm formation usually occurs in the setting of acute myocardial infarction, but also in other rare contexts. Cardiac rupture is associated with an extremely high mortality unless early diagnosis and urgent surgical intervention are provided.
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Neto et al. (2020) conducted a case report in Systemic lupus erythematosus and myocardial rupture (n=1). Cardiac surgery was evaluated. A young female with systemic lupus erythematosus developed a contained myocardial rupture and left ventricular pseudoaneurysm in the absence of coronary artery disease, which was successfully repaired.
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