A Multimodal Imaging Approach to Left Ventricular Aneurysms, Pseudoaneurysms, and Diverticula

Figures

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  Figure 1. Transthoracic Echocardiogram Showing a Dilated Left Ventricle With Wall Akinesia, Reduced Ejection Fraction (34%), a Large Aneurysmal Sac With Thrombus (33 × 90 mm), and Circumferential Pericardial Effusion (A) 2-dimensional imaging, (B) 3-dimensional imaging, (C) contrast-enhanced, and (D) color Doppler. The arrows indicate the aneurysm.

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  Figure 2. Coronary Angiography and Cardiac Magnetic Resonance of Aneurysm (A) Coronary angiography showing a chronic occlusion of the right coronary artery with collateral vessel revascularization (arrow indicates the right coronary artery occlusion). (B and C) Cardiac magnetic resonance revealing an aneurysmal sac in the inferior wall of the left ventricle along with transmural late gadolinium enhancement and a large mural thrombus.

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  Figure 3. Aneurysmectomy (A) Aneurysmectomy via median sternotomy. (B) Thrombus on the left and aneurysmal sac on the right.

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  Figure 4. Transthoracic Echocardiogram Showing Severe Left Ventricular Dysfunction With Akinesia of All Apical Segments, a Small Apical Pseudoaneurysm, and Mild Pericardial Effusion (A) Two-dimensional imaging, (B) Doppler color, and (C) 3-dimensional imaging showing pseudoaneurysm. The arrows indicate the pseudoaneurysm.

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  Figure 5. Cardiac Magnetic Resonance Revealing 2 Small Pseudoaneurysms in the Left Anterior Descending Artery Territory and an Apical Septal Intraventricular Communication The arrow indicates the pseudoaneurysm, and the circle indicates the septal intraventricular communication.

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  Figure 6. Transthoracic Echocardiogram Showing Left Ventricular Diverticulum With Blood Flow in the Cavity of the Diverticulum The arrow indicates the diverticulum.

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  Figure 7. Cardiac Magnetic Resonance Revealing Left Ventricular Diverticulum The arrow indicates the diverticulum.

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  Figure 8. Cardiac CT Angiography for Exclusion of the Presence of Coronary Artery Disease and Showing Left Ventricular Diverticulum Measuring 9 × 7 cm

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  Figure 9. Schematic Illustrations of an Aneurysm and a Pseudoaneurysm In a pseudoaneurysm, the Omax is much smaller than the Dmax of the aneurysmal sac. In a true aneurysm, the maximal internal width of the opening is usually equal to, or wider than any other parallel internal diameter of the aneurysmal cavity. AN. = aneurysm; Ao = aorta; CL = clot; Dmax = maximal parallel internal diameter; LA = left atrium; LV = left ventricle; MV = mitral valvemaximal internal width of the neck.