Aneurisma y pseudoaneurisma ventricular: complicaciones que no debemos olvidar. Una revisión narrativa
DOI:
https://doi.org/10.17533/udea.iatreia.336Palabras clave:
Aneurisma Cardíaco, Aneurisma Falso, Infarto de Miocardio, Taponamiento CardíacoResumen
Introducción: el aneurisma y pseudoaneurisma ventricular son complicaciones del infarto agudo de miocardio con importantes riesgos clínicos. Los aneurismas verdaderos afectan todas las capas del corazón, mientras que los pseudoaneurismas, más propensos a ruptura, están contenidos solo por el pericardio.
Objetivos: proporcionar un enfoque detallado sobre el diagnóstico y el tratamiento del aneurisma y pseudoaneurisma ventricular para mejorar su manejo clínico.
Métodos: se realizó una búsqueda sistemática en bases de datos científicas como PubMed y Cochrane Library, incluyendo estudios observacionales, revisiones y guías clínicas.
Resultados: los aneurismas tienen una incidencia del 11 % y los pseudoaneurismas del 0,02 %. El diagnóstico se basa en estudios de imagen como la ecocardiografía y la resonancia magnética. El tratamiento puede ser conservador o quirúrgico; no obstante, en algunos casos, el pseudoaneurisma puede representar una emergencia quirúrgica.
Conclusiones: el diagnóstico temprano y la revascularización reducen la incidencia de estas complicaciones. El uso de anticoagulantes sigue siendo controversial, y se requieren más investigaciones para determinar su beneficio.
Descargas
Citas
(1) Zoffoli G, Mangino D, Venturini A, Terrini A, Asta A, Zanchettin C, et al. Diagnosing left ventricular aneurysm from pseudo-aneurysm: a case report and a review in literature. J Cardiothorac Surg [Internet]. 2009 Dec 24;4:11. https://doi.org/10.1186/1749-8090-4-11
(2) Gong FF, Vaitenas I, Malaisrie SC, Maganti K. Mechanical Complications of Acute Myocardial Infarction. JAMA Cardiol [Internet]. 2021 Mar;6(3):341-349. https://doi.org/10.1001/jamacardio.2020.3690
(3) Cheng TO. Incidence of ventricular aneurysm in coronary artery disease. Am J Med [Internet]. 1971 Mar;50(3):340–355. https://doi.org/10.1016/0002-9343(71)90223-3
(4) El ouazzani J, Jandou I. Aneurysm and pseudoaneurysm of the left ventricle. Ann Med Surg [Internet]. 2022;75:103405. https://doi.org/10.1016/j.amsu.2022.103405
(5) Tikz H, Balbay Y, Atak R, Terzi T, Gençl Y, Kütük E. The effect of thrombolytic therapy on left ventricular aneurysm formation in acute myocardial infarction: Relationship to successful reperfusion and vessel patency. Clin Cardiol [Internet]. 2001 Oct;24(10):656–662. https://doi.org/10.1002/clc.4960241005
(6) Zuluaga-Santamaría A, Aldana N, Bustamante S, Gutiérrez C, Grand V, Sanín MP, et al. Aneurismas, pseudoaneurismas y divertículos cardiacos. Rev Colomb Radiol [Internet]. 2017;28(1):4593–4599. Disponible en: http://contenido.acronline.org/Publicaciones/RCR/RCR28-1/01_Aneurismas.pdf
(7) Zhang Z, Guo J. Predictive risk factors of early onset left ventricular aneurysm formation in patients with acute ST-elevation myocardial infarction. Heart Lung [Internet]. 2020 Jan 1;49(1):80–85. https://doi.org/10.1016/j.hrtlng.2019.09.005
(8) Lee GY, Song YB, Hahn JY, Choi SH, Choi JH, Jeon ES, et al. Anticoagulation in Ischemic Left Ventricular Aneurysm. Mayo Clin Proc [Internet]. 2015 Apr;90(4):441–449. https://doi.org/10.1016/j.mayocp.2014.12.025
(9) Baethge C, Goldbeck-Wood S, Mertens S. SANRA—a scale for the quality assessment of narrative review articles. Res Integr Peer Rev [Internet]. 2019 Dec 26;4:5. https://doi.org/10.1186/s41073-019-0064-8
(10) Harley HRS. Cardiac ventricular aneurysm. Thorax [Internet]. 1969 Mar 1;24(2):148–172. https://doi.org/10.1136/thx.24.2.148
(11) Ruzza A, Czer LSC, Arabia F, Vespignani R, Esmailian F, Cheng W, et al. Left Ventricular Reconstruction for Postinfarction Left Ventricular Aneurysm: Review of Surgical Techniques. Tex Heart Inst J [Internet]. 2017 Oct 1;44(5):326–335. https://doi.org/10.14503/thij-16-6068
(12) Bisoyi S, Dash AK, Nayak D, Sahoo S, Mohapatra R. Left ventricular pseudoaneurysm versus aneurysm a diagnosis dilemma. Ann Card Anaesth [Internet]. 2016;19(1):169-172. https://doi.org/10.4103/0971-9784.173042
(13) di Summa M, Iezzi F, Oburu G, Mehta N. Huge left ventricular pseudoaneurysm rupture in an African young adult patient. Interact Cardiovasc Thorac Surg [Internet]. 2014 Jul;19(1):160–161. https://doi.org/10.1093/icvts/ivu086
(14) Frances C, Romero A, Grady D. Left ventricular pseudoaneurysm. J Am Coll Cardiol [Internet]. 1998 Sep;32(3):557–561. https://doi.org/10.1016/s0735-1097(98)00290-3
(15) Shambrook JS, Chowdhury R, Brown IW, Peebles CR, Harden SP. Cross-sectional imaging appearances of cardiac aneurysms. Clin Radiol [Internet]. 2010 May;65(5):349–357. https://doi.org/10.1016/j.crad.2010.02.002
(16) Sirena JJ, Garillo R, Villarroel-Ábrego H, Sirena NM, Sirena JF. Aneurismas ventriculares en una población de pacientes con cardiomiopatía chagásica. Rev Colomb Cardiol [Internet]. 2022;29(5):559-567. https://doi.org/10.24875/rccar.21000144
(17) Papanastasiou CA, Zegkos T, Karamitsos TD, Rowin EJ, Maron MS, Parcharidou D, et al. Prognostic role of left ventricular apical aneurysm in hypertrophic cardiomyopathy: A systematic review and meta-analysis. Int J Cardiol [Internet]. 2021 Jun;332:127–132. https://doi.org/10.1016/j.ijcard.2021.03.056
(18) Xia S, Wu B, Zhang X, Hu X. Left ventricular aneurysm in patients with idiopathic dilated cardiomyopathy: clinical analysis of six cases. Neth Heart J [Internet]. 2009 Dec;17(12):475–480. https://doi.org/10.1007/BF03086307
(19) Perillo EF, Canciello G, Borrelli F, Todde G, Imbriaco M, Ordine L, et al. Diagnosis and Clinical Implication of Left Ventricular Aneurysm in Hypertrophic Cardiomyopathy. Diagnostics (Basel) [Internet]. 2023 May 25;13(11):1848. https://doi.org/10.3390/diagnostics13111848
(20) Gómez-Doblas JJ, de Teresa E, Lamas GA. Geometría ventricular e insuficiencia cardíaca. Rev Esp Cardiol [Internet]. 1999 Jan 1;52(1):47–52. Available from: https://www.revespcardiol.org/en-geometria-ventricular-e-insuficiencia-cardiaca-articulo-X0300893299000323
(21) Donahue JK, Chrispin J, Ajijola OA. Mechanism of Ventricular Tachycardia Occurring in Chronic Myocardial Infarction Scar. Circ Res [Internet]. 2024 Feb 2;134(3):328–42. https://doi.org/10.1161/circresaha.123.321553
(22) Yeo TC, Malouf JF, Oh JK, Seward JB. Clinical Profile and Outcome in 52 Patients with Cardiac Pseudoaneurysm. Ann Intern Med [Internet]. 1998;128(4):299-305. https://doi.org/10.7326/0003-4819-128-4-199802150-00010
(23) Xing Y, Wang C, Wu H, Ding Y, Chen S, Yuan Z. Development and Evaluation of a Risk Prediction Model for Left Ventricular Aneurysm in Patients with Acute Myocardial Infarction in Northwest China. Int J Gen Med [Internet]. 2022 Jul;15:6085–6096. https://doi.org/10.2147/ijgm.s372158
(24) Feng Y, Wang Q, Chen G, Ye D, Xu W. Impaired renal function and abnormal level of ferritin are independent risk factors of left ventricular aneurysm after acute myocardial infarction. Medicine (Baltimore) [Internet]. 2018 Aug 1;97(35):e12109. https://doi.org/10.1097/md.0000000000012109
(25) Brinza C, Floria M, Popa IV, Burlacu A. The Prognostic Performance of Ferritin in Patients with Acute Myocardial Infarction: A Systematic Review. Diagnostics (Basel) [Internet]. 2022 Feb 13;12(2):476. https://doi.org/10.3390/diagnostics12020476
(26) Solowjowa N, Nemchyna O, Hrytsyna Y, Meyer A, Hennig F, Falk V, et al. Surgical Restoration of Antero-Apical Left Ventricular Aneurysms: Cardiac Computed Tomography for Therapy Planning. Front Cardiovasc Med [Internet]. 2022 Mar 28;9:763073. https://doi.org/10.3389/fcvm.2022.763073
(27) Solowjowa N, Penkalla A, Dandel M, Novikov A, Pasic M, Weng Y, et al. Multislice computed tomography-guided surgical repair of acquired posterior left ventricular aneurysms: demonstration of mitral valve and left ventricular reverse remodelling. Interact Cardiovasc Thorac Surg [Internet]. 2016 Sep;23(3):383–390. https://doi.org/10.1093/icvts/ivw137
(28) Konen E, Merchant N, Gutierrez C, Provost Y, Mickleborough L, Paul NS, et al. True versus False Left Ventricular Aneurysm: Differentiation with MR Imaging—Initial Experience. Radiology [Internet]. 2005 Jul;236(1):65–70. https://doi.org/10.1148/radiol.2361031699
(29) Engel J, Brady WJ, Mattu A, Perron AD. Electrocardiographic ST segment elevation: Left ventricular aneurysm. Am J Emerg Med [Internet]. 2002 May;20(3):238–242. https://doi.org/10.1053/ajem.2002.32634
(30) Visser CA, Kan G, David GK, Lie KI, Durrer D. Echocardiographic-cineangiographic correlation in detecting left ventricular aneurysm: A prospective study of 422 patients. Am J Cardiol [Internet]. 1982 Aug;50(2):337–341. https://doi.org/10.1016/0002-9149(82)90185-0
(31) McDonagh TA, Metra M, Adamo M, Gardner RS, Baumbach A, Böhm M, et al. 2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure. Eur Heart J [Internet]. 2021 Sep 21;42(36):3599–3726. https://doi.org/10.1093/eurheartj/ehab368
(32) Taylor RS, Dalal HM, Zwisler AD. Cardiac rehabilitation for heart failure: ‘Cinderella’ or evidence-based pillar of care? Eur Heart J [Internet]. 2023 May 1;44(17):1511–1518. https://doi.org/10.1093/eurheartj/ehad118
(33) McDonagh TA, Metra M, Adamo M, Gardner RS, Baumbach A, Böhm M, et al. 2023 Focused Update of the 2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure. Eur Heart J [Internet]. 2023 Oct 1;44(37):3627-3639. https://doi.org/10.1093/eurheartj/ehad195
(34) Al-Khatib SM, Stevenson WG, Ackerman MJ, Bryant WJ, Callans DJ, Curtis AB, et al. 2017 AHA/ACC/HRS guideline for management of patients with ventricular arrhythmias and the prevention of sudden cardiac death. Heart Rhythm [Internet]. 2018 Oct;15(10):e190-e252. https://doi.org/10.1016/j.hrthm.2017.10.035
(35) Larson J, Rich L, Deshmukh A, Judge EC, Liang JJ. Pharmacologic Management for Ventricular Arrhythmias: Overview of Anti-Arrhythmic Drugs. J Clin Med [Internet]. 2022 Jun 6;11(11):3233. https://doi.org/10.3390/jcm11113233
(36) Amin M, Farwati M, Hilaire E, Siontis KC, Madhavan M, Kapa S, et al. Catheter ablation of ventricular tachycardia in patients with postinfarction left ventricular aneurysm. J Cardiovasc Electrophysiol [Internet]. 2021 Dec 27;32(12):3156–3164. https://doi.org/10.1111/jce.15273
(37) John RM, Tedrow UB, Koplan BA, Albert CM, Epstein LM, Sweeney MO, et al. Ventricular arrhythmias and sudden cardiac death. Lancet [Internet]. 2012 Oct;380(9852):1520–1529. https://doi.org/10.1016/s0140-6736(12)61413-5
(38) Windecker S, Kolh P, Alfonso F, Collet JP, Cremer J, Falk V, et al. 2014 ESC/EACTS Guidelines on myocardial revascularization. Eur Heart J [Internet]. 2014 Oct 1;35(37):2541–2619. https://doi.org/10.1093/eurheartj/ehu278
(39) Atik FA, Navia JL, Vega PR, Gonzalez-Stawinski GV, Alster JM, Gillinov AM, et al. Surgical Treatment of Postinfarction Left Ventricular Pseudoaneurysm. Ann Thorac Surg [Internet]. 2007 Feb;83(2):526–531. https://doi.org/10.1016/j.athoracsur.2006.06.080
(40) Dudiy Y, Jelnin V, Einhorn BN, Kronzon I, Cohen HA, Ruiz CE. Percutaneous Closure of Left Ventricular Pseudoaneurysm. Circ Cardiovasc Interv [Internet]. 2011 Aug;4(4):322–326. https://doi.org/10.1161/circinterventions.111.962464
(41) Lorusso R, Cubeddu RJ, Matteucci M, Ronco D, Moreno PR. Ventricular Pseudoaneurysm and Free Wall Rupture After Acute Myocardial Infarction: JACC Focus Seminar 4/5. J Am Coll Cardiol [Internet]. 2024 May;83(19):1902–1916. https://doi.org/10.1016/j.jacc.2023.10.054
(42) Heidenreich PA, Bozkurt B, Aguilar D, Allen LA, Byun JJ, Colvin MM, et al. 2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. J Am Coll Cardiol [Internet]. 2022 May;79(17):e263–e421. https://doi.org/10.1016/j.jacc.2021.12.012
(43) Cinq-Mars A, Veilleux SP, Voisine P, Dagenais F, O’Connor K, Bernier M, et al. The Novel Use of Heart Transplantation for the Management of a Case With Multiple Complications After Acute Myocardial Infarction. Can J Cardiol [Internet]. 2015 Jun;31(6):816–818. https://doi.org/10.1016/j.cjca.2015.01.024
(44) Lynch PJ, Jaffe C. Heart left ventricular aneurysm short axis view [Internet]. Photo. New Haven (CT): Yale University School of Medicine, Center for Advanced Instructional Media; 2000 [cited 2024 Oct 28]. Available from: https://drive.google.com/file/d/1MLHBRZCq7PEpJjfBn-x1V1oaEwcfywqh
Descargas
Publicado
Cómo citar
Número
Sección
Licencia
Derechos de autor 2025 Iatreia
Esta obra está bajo una licencia internacional Creative Commons Atribución-NoComercial-CompartirIgual 4.0.
Los artículos publicados en la revista están disponibles para ser utilizados bajo la licencia Creative Commons, específicamente son de Reconocimiento-NoComercial-CompartirIgual 4.0 Internacional.
Los trabajos enviados deben ser inéditos y suministrados exclusivamente a la Revista; se exige al autor que envía sus contribuciones presentar los formatos: presentación de artículo y responsabilidad de autoría completamente diligenciados.
