Conservative management of a serpentine-like left ventricular pseudoaneurysm with organized thrombus via CABG without plication may yield favorable medium-term outcomes.
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May support CABG without plication in select organized LV pseudoaneurysms; leaves open need for prospective validation.
A 73 year old man developed a left ventricular pseudoaneurysm following acute myocardial infarction. Coronary angiography showed triple vessel disease with total occlusion of the right coronary artery. On left ventriculography, a serpentine-like pseudoaneurysm was demonstrated that originated from the posterobasal wall of the left ventricle and extended to the right ventricular free wall. He underwent coronary artery bypass surgery with no plication of the pseudoaneurysm. An organised thrombus was also found within the cavity of the pseudoaneurysm. He was doing well approximately eight months after the operation. The prognosis might be determined by the organised thrombus, the serpentine-like structure of pseudoaneurysm, the coronary revascularisation, and the vigorous medical management.
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Hung et al. (1998) studied this question.
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