Afzal Hussain, Aziz Jamal Naqvi.
Resection of Left Ventricular Pseudo aneurysm Secondary to blunt chest trauma.
J Coll Physicians Surg Pak Jan ;12(8):493-7.

Rupture of the left ventricle is uncommon but has been reported after chest trauma, myocardial infarction, infective endocarditis and myocardial abscess. We report a case of blunt chest trauma leading to formation of a false aneurysm of the left ventricle that was repaired surgically with successful outcome.

Case: A six years old female patient presented with history of recurrent chest infections, weight loss and feeling generally unwell. Clinical examination was unremarkable apart from pallor and wasting as a result of long-standing illness. Investigations showed raised white cell count upto 20,300 cm3 with marked eosinophilia upto 14% with erythrocyte sedimentation rate of 15 and normal platelet count. Indirect heamagglutination test and tuberculin test was negative. Chest x-rays showed a well-circumscribed calcified lesion 4.0 x 4.5 cms in the anterior segment of the left lower lobe. CT scan confirmed the above findings with densely calcified margins in the anterior segment of the left lower lobe abutting the pleura and also the pericardial margin along the left heart border. The rest of the lung fields were clear with no mediastinal or hilar lymph adenopathy. A radiological diagnosis of calcified cyst (hydated cyst) or calcified lung abscess was made. An echocardiogram and a CT scan confirmed the diagnosis. The case was referred to pediatric surgeon for exploration. Patient underwent left posterolateral thoracotomy in November, 1999 and the calcified mass was found to be in the pericardium in continuity with the myocardium along the left border of the heart. On aspiration, fresh blood came out which raised the suspicion of calcified false aneurysm of the left ventricle. The procedure was abandoned and patient was referred to the cardiovascular surgeon for further management. Patient made good recovery from the thoracotomy operation and was discharged from the hospital. She was re-admitted for further assessment. On positive questioning, the father recalled blunt injury, a few years ago, to the left side of her chest, when she fell a few steps down the stairs while playing. She was given oral analgesia by her general practitioner for pain but it was never serious enough to warrant hospital admission or any further investigation. A repeat CT scan supported the diagnosis of left ventricular pseudo-aneurysm. She was finally operated upon for the resection of this pseudo-aneurysm in January, 2000. At operation, through the median sternotomy, the left ventricular apex was found adherent to an hard calcified mass which extended through the pericardium and the pleura on to the surface of the left diaphragm. A routine cardio-pulmonary bypass was instituted and the heart was arrested with cold crystalloid cardioplegia. The left ventricular apex was dissected free from the calcified mass and a small hole in it was closed with pledgeted 4/0 prolene sutures. The calcified mass, which contained organized clots, was removed piecemeal. Her postoperative recovery was uneventful and she was discharged from the hospital on the 10th postoperative day.

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