Cardiac magnetic resonance characterization of an iatrogenic left ventricular apical pseudo-aneurysm.

et al. Impact of viability and scar tissue on response to cardiac resynchronization therapy in ischaemic heart failure patients. et al. Multicentre study using strain delay index for predicting response to cardiac resynchronization therapy (MUSIC study). Reverse remodelling induces progressive ventricular resynchronization after cardiac resynchronization therapy 'from vicious to virtuous cycle'.acteristics of heart failure patients associated with good and poor response to cardiac resynchronization therapy: a PROSPECT (Predictors of Response to CRT) sub-analysis. duration to predict response to cardiac resynchronization therapy in patients with end-stage heart failure. Morbidity and mortality in heart failure patients treated with cardiac resynchronization therapy: influence of pre-implantation characteristics on long-term outcome. MRI to investigate myocardial scar and coronary venous anatomy using a slow infusion of dimeglumine gadobenate in patients undergoing assessment for cardiac resynchronization therapy. A et al. Non-invasive visualization of the cardiac venous system in coronary artery disease patients using 64-slice computed tomography. Comparison of left ventricular lead placement via the coronary venous approach versus lateral thoracotomy in patients receiving cardiac resynchronization therapy. et al. Coronary vein angioplasty to facilitate implantation of left ventricular lead. A 68-year-old woman underwent successful emergency repair of a type A aortic dissection (Panel A). Post-operative course was complicated by persistent fever. An ECG-gated CT aortic angiogram confirmed the clinical suspicion of intra-thoracic collection, but also identified a left ventricular apical pseudoaneurysm or diver-ticulum (Panels B and C). Transthoracic echocar-diogram demonstrated an echo-free sac with thin walls at the apex (Panel D) with normal con-tractility of the adjacent myocardium. Direct communication with the left ventricular chamber was confirmed by colour Doppler examination (Panel E). Cardiac magnetic resonance (CMR) showed focal late-gadolinium enhancement of the walls of the sac of pseudoa-neurysm, supporting an iatrogenic aetiology over congenital diverticulum (Panels F and G) with a small amount of pericardial fluid. The patient returned to the operating theatre for surgical repair. The pseudo-aneurysm was identified and reinforced with the bovine pericardium (Panel H). The ventilation catheter used to relieve excessive ventricular pressure during the initial surgery (Panel I) was considered the most likely culprit for the myocardial injury. Despite this unusual complication, the patient made an otherwise uneventful recovery. This case demonstrates the unique ability of CMR to characterize the myocardium, confirming the iatrogenic origin of an asymptomatic apical pseudoaneurysm and assisting in clinical management.