Prognostic and surgical implications of true and false left ventricular aneurysms are very different. The distinction between these two entities can be established before cardiac catheterization by means of two-dimensional echocardiography and radionuclide imaging. Both methods, however, as well as LV angiography, may fall in such distinction when the size of the communication between the LV and the accessory chamber cannot be definitely assessed. Pulsed Doppler echocardiography may be a useful complement, providing a comprehensive evaluation of flow dynamics. Color flow mapping represents a new step in this subset, with the great advantage of displaying spatial oriented flow patterns. To our knowledge this is the first case of a postsurgical LV pseudoaneurysm detected by two-dimensional color Doppler echocardiography. buy paxil online
A 51-year-old woman was referred to our hospital because of mitral regurgitation and cerebral embolism secondary to Staphylococcus aureus endocarditis. A 25-day antibiotic course with vancomycin and tobramycin was ineffective, with persistent fever and development of a ring abscess on echocardiographic study Elective surgery was performed, and a biologic prosthesis was implanted at the mitral position with simultaneous debridement of the perian-nular abscess. The same antibiotic treatment was continued postoperatively for another three weeks. In spite of disappearance of fever, serial echocardiographic control tracings showed the development of a posterobasal accessory chamber, near the previous localization of the abscess (Fig 1, top). Color flow mapping (Toshiba SSH65) established a firm diagnosis of pseudoaneurysm, by visualization of a systolic turbulent jet crossing the narrow neck towards the accessory chamber (Fig 1, bottom). Progressive expansion of this chamber mandated a new surgical procedure. At operation, noninvasive findings were confirmed, and the pseudoaneurysm was resected. Postoperative course was uneventful.
Figure 1A (upper). Two-dimensional echocardiogram (apical two-chamber view). An accessory chamber (PS) adjacent to left ventricular posterior wall is evident. LA is left atrium; LV, left ventricle; PS, pseudoaneurysm. B (lower). Color Doppler flow mapping at the same level. A jet of turbulent flow is noted crossing the communication between both chamber. A “mosaic” flow pattern completely fills the accessory chamber. Systolic flow moving away from the transducer is represented as blue area. Red area indicates high velocity flow with color reversal (aliasing).