Coincidence of True and False Aneurysm with Rupture into
the Right Atrium

Zachary H. George, MD, Henry Meltser, MD, Jason Zelenka, MD, Elisabeth Von der Lohe, MD
Zachary H. George, MD, Henry Meltser, MD, Jason Zelenka, MD, Elisabeth Von der Lohe, MD
Case Report. A 60-year-old man without significant past medical history presented to the emergency department with a six-day history of intermittent mid-epigastric pain with associated nausea, diaphoresis and exertional dyspnea. Aspirin was self administered for analgesia with increasing frequency over the six days prior to admission with minimal relief. The patient described gradual worsening of exertional dyspnea over a six-day period prior to admission; however, no other associated symptoms such as palpitations, paroxysmal nocturnal dyspnea or leg edema, were present upon presentation to the emergency room. His cardiovascular risk factors included a 40-year history of tobacco use, sedentary lifestyle due to occupation (truck driver), male sex, and age. Physical examination revealed: blood pressure 100/60 mmHg in both arms in supine position, heart rate 90 beats per minute, temperature 95.9?F and respiratory rate 24 breaths per minute with digital oximetry demonstrating 88% saturation on room air. His neck examination revealed no jugular venous distention and no carotid bruits. The cardiac examination demonstrated a regular S1and S2 with a II/VI holo-systolic murmur heard loudest at the left lower sternal border. The pulmonary exam revealed decreased breath sounds throughout both lung fields. His abdomen was soft and non-tender with normal bowel sounds. His extremity and neurological exam was unremarkable. His laboratory data included normal electrolytes, a hemoglobin of 11.2 g/dL, a troponin-I of 5.6 ng/dL (normal
1. Das AK, Wilson GM, Furnary AP. Coincidence of true and false left ventricular aneurysm. Ann Thorac Surg 1997;64:831–834. 2. Doig JC, Au J, Dark JH, Furniss SS. Post-infarction communication between a left ventricular aneurysm and the right atrium. Eur Heart J 1992;13:1006–1007. 3. Hole T, Wiseth R, Levang O. Post-infarction left ventricle to right atrium fistula diagnosed by transthoracic Doppler echocardiography. Eur Heart J 1995;16:866–868. 4. Flaherty GT, O’Neill MN, Kieran M, et al. True aneurysm of the left ventricle: a case report and literature review. Clin Anat 2001;14:363–368. 5. Gobel FL, Visudh-Arom K, Edwards JE. Pseudoaneurysm of the left ventricle leading to recurrent pericardial hemorrhage. Chest 1971;59:23–27. 6. March KL, Sawada SG, Tarver RD, et al. Current concepts of left ventricular pseudoaneurysm: Pathophysiology, therapy, and diagnostic imaging methods. Clin Cardiol 1989;12:531–540. 7. Gerbode F, Melrose D, Osborn J. Syndrome of left ventricular-right atrial shunt: Successful surgical repair of defect in 5 cases with observation of bradycardia on closure. Ann Surg 1958;148:433–446. 8. Silverman NA, Sethi GK, Scott SM. Acquired left ventricular-right atrial fistula following aortic valve replacement. Ann Thorac Surg 1980;30:482–486. 9. Seabra-Gomes R, Ross DN, Gonzalez-Lavin L. Iatrogenic left ventricular — Right atrial fistula following mitral valve replacement. Thorax 1973;28:235–241. 10. Cantor S, RSanderson R, Cohn K. Left ventricular-right atrial shunt due to bacterial endocarditis. Chest 1971;60:552–554. 11. Dunseth W. Acquired cardiac septal defect due to thoracic trauma. J Surg Research 1965;5:42–49. 12. Shepard AP, Steinke JM, McMahan CA. Effect of oximetry error on the diagnostic value of the Qp/Qs ratio. Int J Cardiol 1997;61:247–259. 13. Kern MJ. The Cardiac Catheterization Handbook (3rd ed.) St. Louis: Mosby Publishing. 1999;pp154–164.