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J Thorac Cardiovasc Surg 2009;137:247-249
© 2009 The American Association for Thoracic Surgery

Brief Communication

Repair of acute postinfarction atrioventricular dehiscence in a patient with posterior left ventricular aneurysm

Igor E. Konstantinov, MD, PhD*, Pankaj Saxena, MCh, DNB, Shane Ling, MB, BS, Trenton Barrett, MB, BS

Department of Cardiothoracic Surgery, Sir Charles Gairdner Hospital, University of Western Australia, Perth, Australia

Received for publication January 26, 2008; revisions received February 13, 2008; accepted for publication February 23, 2008.

* Address for reprints: Igor E. Konstantinov, MD, PhD, Department of Cardiothoracic Surgery, Sir Charles Gairdner Hospital, Perth, WA 6009, Australia. (Email: konstantinov.igor@alumni.mayo.edu).

The first 20% of the full text of this article appears below.

Acute postinfarction atrioventricular (AV) dehiscence is a rare complication. If the dehiscence is contained, it may form a pseudoaneurysm. The pseudoaneurysm has little strength and is prone to rupture. Left ventricular (LV) pseudoaneurysm is most commonly located at the posterior basal segment, where it is likely to be contained. Repair of postinfarction LV pseudoaneurysm is associated with 20% to 35.7% mortality even in the modern era.1-3Go We can report the successful management of an acute postinfarction AV dehiscence in a patient with a true posterior LV aneurysm and severe mitral insufficiency.

Clinical Summary

A 57-year-old diabetic woman had a non-ST elevation myocardial infarction and pulmonary edema. Echocardiography demonstrated severe mitral insufficiency resulting from tethering of the posterior leaflet at P2 and P3 segments, LV ejection fraction of 34%, a true posterior LV aneurysm, and severe calcification of the posterior mitral annulus with an AV dehiscence and a pseudoaneurysm. Magnetic resonance imaging confirmed the findings and delineated an AV dehiscence of 5 mm in diameter . . . [Full Text of this Article]






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