Color Doppler Diagnosis of Left Ventricular Pseudoaneurysm: Discussion

24 Feb

Color Doppler Diagnosis of Left Ventricular Pseudoaneurysm: DiscussionLeft ventricular pseudoaneurysm formation results usually as a complication of acute myocardial infarction. However, this anomaly can be associated with several other etiologies. Until recently, a firm diagnosis of this entity relied on cardiac angiography. The advent of two-dimensional echo cardiography made feasible the noninvasive identification of the false aneurysm, but in certain cases, the characteristic narrow neck communicating between the left ventricle and the false chamber can not be seen. The combined utilization of pulsed wave Doppler can help to establish a firm diagnosis in these circumstances, by detecting a turbulent systolic flow pattern across the point of communication, even if the connection between both chambers is not clearly visualized. diabetes medications

Doppler color flow mapping is a recently developed technique that, by superimposing intracavitary flow patterns on real time echocardiographic images, provides spatial orientation and an estimation of the magnitude of abnormal flows.
The two dimensional study disclosed the classic findings of a posterobasal left ventricular pseudoaneurysm (Fig 1, top). The color Doppler detected a systolic turbulent flow crossing the narrow neck towards the accessory cavity. At end systole, the entire cavity was filled by a “mosaic” pattern (Fig 1, bottom).
To our knowledge, this is the first report of color flow mapping in a pseudoaneurysm. In this case, the color flow mapping permitted the firm diagnosis of the pseudoaneurysm by demonstrating the flow pattern superimposed on the anatomic images obtained by two-dimensional echo. In less clear cut cases of pseudoaneurysm, it is not clear that current color Doppler technology will be of sufficient sensitivity to detect the high velocity jet across the neck of the false aneurysm.