Publications by authors named "Pedro Bernardo Almeida"

20 Publications

  • Page 1 of 1

Echocardiographic diagnosis of hepatopulmonary syndrome: a valuable tool to remember.

Intern Emerg Med 2021 Apr 9. Epub 2021 Apr 9.

Department of Cardiology, Centro Hospitalar Universitário de São João, E.P.E., Alameda Prof. Hernâni Monteiro, 4200-319, Porto, Portugal.

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http://dx.doi.org/10.1007/s11739-021-02731-xDOI Listing
April 2021

Embolization of a left atrial appendage closure device.

Rev Port Cardiol (Engl Ed) 2021 Mar 20;40(3):247-248. Epub 2021 Jan 20.

Serviço de Cardiologia, Centro Hospitalar Universitário de São João, E.P.E., Porto, Portugal; Faculdade de Medicina da Universidade do Porto, Porto, Portugal.

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http://dx.doi.org/10.1016/j.repc.2019.12.010DOI Listing
March 2021

Myocardial dysfunction in Takotsubo syndrome: More than meets the eye?

Rev Port Cardiol (Engl Ed) 2019 Apr 16;38(4):261-266. Epub 2019 May 16.

Serviço de Cardiologia, Centro Hospitalar Universitário de São João, E.P.E., Porto, Portugal.

Introduction: Takotsubo syndrome (TTS) is characterized by transient left ventricular (LV) dysfunction, typically mimicking an anterior wall myocardial infarction (MI), without obstructive coronary artery disease. In the few published reports assessing myocardial deformation in TTS and MI, no consistent differences have been described between the two entities. We sought to characterize global and regional function in TTS and to compare it with a population with MI.

Methods: Clinical data, including echocardiography, were gathered from 17 TTS patients and 20 anterior wall ST-segment elevation myocardial infarction (STEMI) controls. Peak systolic longitudinal strain was determined for each LV segment using speckle tracking imaging, and global and mean apical, midventricular and basal longitudinal strain were calculated from these.

Results: Both TTS and STEMI patients presented significant LV systolic dysfunction, and there were no significant differences in ejection fraction or global longitudinal strain. Regional longitudinal strain was more severely impaired in basal inferolateral and mid anterolateral segments in the TTS group and in apical anteroseptal segments in the STEMI group. Mean longitudinal strain was worse in the basal segments of TTS patients (-9.8±2.9 vs. -12.4±4.1%, p=0.010), with no significant differences in mid and apical segments. The basal/apical ratio was significantly lower in this group as well (1.51±0.86 vs. 2.94±1.88, p=0.006).

Conclusions: While both TTS and STEMI feature significantly impaired global systolic function, we found a regional pattern of worse basal longitudinal strain and a lower basal/apical ratio in the former. These suggest generalized myocardial impairment in TTS, providing new clues about its pathophysiology and possible specific echocardiographic changes.
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http://dx.doi.org/10.1016/j.repc.2018.07.008DOI Listing
April 2019

IgG4-related Disease Presenting as Cardiac Arrest.

Rev Esp Cardiol (Engl Ed) 2019 Mar 16;72(3):268-270. Epub 2018 Mar 16.

Cardiology Department, Centro Hospitalar São João, Porto, Portugal; Faculty of Medicine, Porto University, Porto, Portugal.

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http://dx.doi.org/10.1016/j.rec.2018.02.010DOI Listing
March 2019

A rare primary cardiac benign tumour: diagnosis by non-invasive cardiac imaging.

Acta Cardiol 2017 Jun 21;72(3):345-346. Epub 2017 Mar 21.

a Serviço de Cardiologia, Centro Hospitalar de São João , Porto , Portugal.

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http://dx.doi.org/10.1080/00015385.2017.1305198DOI Listing
June 2017

Prognostic Value of Osteoprotegerin in Acute Heart Failure.

Can J Cardiol 2015 Oct 9;31(10):1266-71. Epub 2015 Apr 9.

Department of Internal Medicine, São João Hospital Centre, Porto, Portugal; Department of Medicine, University of Porto Medical School, Porto, Portugal.

Background: Osteoprotegerin (OPG) is promising as a predictor of adverse prognosis in patients with acute coronary syndromes and chronic heart failure. Its prognostic value in acute heart failure (AHF) is unknown. The aim of this study was to assess the prognostic value provided by serum OPG levels at discharge after an admission for AHF.

Methods: In a prospective study, we enrolled 338 patients consecutively admitted with AHF to the internal medicine department of a tertiary care university hospital in Porto, Portugal between March 2009 and December 2010. OPG was measured using a commercial enzyme-linked immunosorbent assay and was both analyzed as a continuous variable and categorized by quartiles. Patients were followed for up to 6 months after discharge to ascertain the occurrence of all-cause death or hospital readmission resulting from AHF.

Results: During follow-up, 119 patients died or were readmitted for AHF. A graded increase in the risk of the combined end point was observed across quartiles of OPG. At 6 months, the cumulative risk of the end point was 25% for the first quartile and 50% for the fourth quartile. The multivariable adjusted risk of death or hospitalization for AHF increased progressively across categories of OPG up to a statistically significant 2.44-fold increase in risk in the highest category (P for linear trend = 0.002, ie, by 5% per 10 pg/mL increase in OPG).

Conclusions: Serum OPG was directly associated with a higher probability of death or readmission for AHF within 6 months, irrespective of other known prognostic markers. This was true both when the ejection fraction was preserved and when it was reduced.
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http://dx.doi.org/10.1016/j.cjca.2015.04.003DOI Listing
October 2015

Late device embolization in a persistent mitral paravalvular leak.

Rev Port Cardiol 2015 Apr 1;34(4):291.e1-4. Epub 2015 Apr 1.

Serviço de Cardiologia, Hospital de São João, Porto, Portugal.

An 83-year-old man with severe organic mitral regurgitation underwent mitral valve surgery with implantation of a biologic prosthesis. Four months later he presented with hemolytic anemia and heart failure due to severe paravalvular regurgitation. Since the patient refused surgery, the paravalvular leak was closed percutaneously using two Amplatzer devices, with angiographic and clinical success. Two months after the intervention he developed heart failure again and embolization of one of the devices was documented, with significant worsening of paravalvular regurgitation. A redo percutaneous closure was attempted but although initially promising, was ultimately unsuccessful as heart failure symptoms and hemolytic anemia persisted. Surgical correction was the final solution for this case. This is the second case of late device embolization reported in the literature and highlights the importance of careful long-term follow-up of such patients, as late complications, although rare, may occur.
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http://dx.doi.org/10.1016/j.repc.2014.10.010DOI Listing
April 2015

Prognostic value of sST2 added to BNP in acute heart failure with preserved or reduced ejection fraction.

Clin Res Cardiol 2015 Jun 14;104(6):491-9. Epub 2015 Jan 14.

Department of Internal Medicine, São João Hospital Centre, Alameda Prof. Hernâni Monteiro, 4200-319, Porto, Portugal,

Background: Natriuretic peptides and suppression of tumorigenicity 2 (ST2) represent two different physiopathological pathways. We evaluated the prognostic accuracy and complementarity of B-type natriuretic peptide (BNP) and soluble ST2 (sST2) plasma levels at discharge from a hospital admission for acute heart failure, both in patients with preserved (HFpEF) and depressed (HFrEF) systolic function.

Methods And Results: We enrolled 195 consecutive patients discharged alive and followed them prospectively for 6 months. The endpoint was all-cause death or hospital readmission for heart failure. Seventy-six patients had HFpEF and 119 had HFrEF, of whom 23 (30.3%) and 43 (36.1%) reached the combined endpoint, respectively. In both HFpEF and HFrEF, having the two biomarkers into account added prognostic information, with the highest risk in patients with both biomarkers above the median in their group (approximately 40% hospitalization-free survival in both groups at 6 months). These associations translated into a significant fourfold increase in risk of the endpoint for one elevated biomarker and sevenfold for both biomarkers elevated in HFrEF, and no association for one elevated biomarker and fivefold increase in risk for both biomarkers elevated in HFpEF. Considering the reclassification of risk added to BNP by measurement of sST2, net reclassification index was 0.31 (p = 0.21) among patients with HFpEF and 0.70 (p < 0.001) among patients with HFrEF.

Conclusions: sST2 provides robust prognostic information in acute heart failure with HFrEF, while this pattern was less clear in HFpEF. When sST2 was measured together with BNP, it improved prognostic accuracy in both groups, more clearly in HFrEF.
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http://dx.doi.org/10.1007/s00392-015-0811-xDOI Listing
June 2015

Global longitudinal strain as a potential prognostic marker in patients with chronic heart failure and systolic dysfunction.

Rev Port Cardiol 2014 Jul-Aug;33(7-8):403-9. Epub 2014 Aug 23.

Cardiology Department, Centro Hospitalar de S. João, Porto, Portugal.

Introduction And Objective: The prognostic value of myocardium deformation measurements in chronic heart failure (CHF) is still poorly addressed. The purpose of this study was to evaluate the correlation of left ventricular (LV) global longitudinal strain (GLS) with clinical and prognostic indicators in patients with CHF and systolic dysfunction.

Methods: Ambulatory patients with CHF and LV ejection fraction (LVEF) <45% were studied by two-dimensional and Doppler transthoracic echocardiogram with assessment of GLS. An indication of prognostic status was obtained by the Seattle Heart Failure Model (SHFM) prognostic estimates for life expectancy.

Results: We included 54 CHF patients (mean age 55±12 years; 80% male). GLS was significantly correlated with NYHA functional class (r=0.41, p=0.002), BNP levels (r=0.47, p=0.001), LVEF (r=-0.69, p<0.001) and LV end-diastolic pressure, assessed by E/e' ratio (r=0.35, p<0.014) and left atrial maximal volume index (r=0.57, p<0.001). A significant correlation was found between GLS and SHFM prognostic estimates for life expectancy (r=-0.41, p=0.002). The multivariate logistic regression analysis showed that GLS independently predicted an estimated life expectancy <10 years (OR 2.614 [95% CI 1.010-6.763]). The corresponding area under the ROC curve was 0.802 (0.653-0.951) and the best obtained threshold was -9.5 (80% sensitivity, 65% specificity, p=0.003).

Conclusions: GLS was strongly associated with a higher disease severity status and predicted a lower prognostic estimate for life expectancy.
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http://dx.doi.org/10.1016/j.repc.2014.01.023DOI Listing
July 2016

Selection of patients for percutaneous balloon mitral valvotomy: is there a definitive limit for the Wilkins score?

Rev Port Cardiol 2013 Nov 14;32(11):873-8. Epub 2013 Nov 14.

Serviço de Cardiologia, Centro Hospitalar de São João, Porto, Portugal. Electronic address:

Aim: The aim of this study was to determine the early and long-term results of percutaneous balloon mitral valvotomy (PBMV) in patients with Wilkins score (WS) between 9 and 11.

Methods: We performed a retrospective review of clinical records of patients with rheumatic mitral stenosis who underwent PBMV between November 1991 and March 2008. Follow-up was obtained by telephone interview and/or clinical records. The procedure was considered unsuccessful when post-procedure mitral valve area was <1.5 cm(2).

Results: We analyzed 124 patients, 108 (87.1%) of them women. Mean age at the time of repair was 46 ± 11 years and mean follow-up time was 10 ± 4 years. Before the procedure, 100 patients (80.6%) had WS ≤ 8 and 24 (19.4%) were in the "gray zone" (>8 and <11). Patients with WS ≤ 8 and patients in the gray zone had similar ages at first intervention (45 ± 11 vs. 49 ± 11 years; p=0.095) and follow-up time (10 ± 4 vs. 11 ± 5 years; p=0.55). There were no differences between groups in gender (women: 86% vs. 92%; p=0.735), or in baseline echocardiographic measurements (mitral valve area by planimetry 1.0 cm(2) [P25-P75: 0.9-1.1] vs. 0.9 [P25-P75: 0.8-1.2], p=0.514; pulmonary artery systolic pressure 53 mmHg [P25-P75: 45-63] vs. 50 [P25-P75: 44-54], p=0.823]; left atrial diameter >55 mm [16.5% vs. 13.6%, p=1.00]; mitral regurgitation [46.5% vs. 37.5%, p=0.428]) or baseline transmitral gradient (13 mmHg [P25-P75: 10-19] vs. 13 mmHg [P25-P75: 7-20]). Improvements in mitral valve area by planimetry and in hemodynamic gradient were similar in the two groups (0.91 ± 0.39 cm(2) vs. 0.84 ± 0.44 cm(2), p=0.55; 8.8 ± 5.3 mmHg vs. 7.3 ± 5.9 mmHg, p=0.275, respectively). There were no significant differences in major complications or success rates (4.0 vs. 12.5 p=0.131; 89.9% vs. 95.8%, p=0.69) or in need for urgent surgery or future reintervention (2.0 vs. 8.3%, p=0.168; 22% vs. 27.3%, p=0.594). In-hospital mortality occurred only in patients in the WS gray zone (2 [8.3%] vs. 0%, p=0.04), one death (4.2% vs. 0%, p=0.194) possibly being related to a higher WS (secondary to stroke) and the other as a consequence of peripheral vascular complication. Improvements in NYHA functional class soon after the procedure and during follow-up were similar in the two groups. Total mortality was similar in the two groups (3.1 vs. 8.7%, p=0.244).

Conclusions: PBMV was a safe and effective procedure in patients in the WS gray zone. Optimal results can be achieved in these patients if they are carefully selected and operated at experienced centers.
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http://dx.doi.org/10.1016/j.repc.2013.02.017DOI Listing
November 2013

Ischemia induced by coronary steal through a patent mammary artery side branch: a role for embolization.

Rev Port Cardiol 2013 Jun 25;32(6):531-4. Epub 2013 Jun 25.

Serviço de Cardiologia do Centro Hospitalar Tâmega e Sousa, Penafiel, Portugal.

Non-occlusion of the internal mammary artery side branches may cause ischemia due to flow diversion after coronary artery bypass grafting. The authors present the case of a 67-year-old man with recurrent angina after undergoing myocardial revascularization with a left internal mammary artery to left anterior descending bypass. He presented with impaired anterior wall myocardial perfusion in the setting of a patent left internal mammary artery side branch. Effective percutaneous treatment was carried out through coil embolization, with improved flow and clinical symptoms, confirmed through ischemia testing. Coronary steal through a patent mammary artery side branch is a controversial phenomenon and this type of intervention should be considered only in carefully selected patients.
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http://dx.doi.org/10.1016/j.repc.2012.09.011DOI Listing
June 2013

Atrial Septal Defect in a Very Old Woman.

Cardiol Res 2013 Feb 8;4(1):41-44. Epub 2013 Mar 8.

Servico de Medicina Interna, Centro Hospitalar Sao Joao, Portugal; Unidade I&D Cardiovascular do Porto, Faculdade de Medicina da Universidade do Porto, Portugal.

Atrial Septal Defect (ASD) is one of the most frequently congenital heart diseases in adults and it is often asymptomatic until adulthood. We report a case of a 90-year-old woman admitted to hospital with dyspnea and orthopnea insidiously progressing over the preceding 5 years and becoming severe with dyspnea on minimal activities, orthopnea and paroxysmal nocturnal dyspnea, in the last 2 weeks. The transthoracic echocardiogram revealed an atrial septal defect ostium secundum type, with left-to-right shunt, moderate to severe tricuspid insufficiency, severe pulmonary hypertension (72 mmHg) and preserved biventricular function. With diuretic therapy optimization the patient showed symptomatic improvement. This present case represents and unusual and very late presentation of an atrial septal defect ostium secundum type, which is usually diagnosed at the mild adult age. Our patient lived symptom-free for over 80 years.
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http://dx.doi.org/10.4021/cr254eDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5358187PMC
February 2013

Double-chambered left ventricle plus left ventricular non-compaction: report of an abnormal association.

Eur Heart J Cardiovasc Imaging 2013 Feb 10;14(2):127. Epub 2012 Sep 10.

Cardiology Department, Centro Hospitalar de São João, Alameda Prof. Hernâni Monteiro, 4200-319 Porto, Portugal.

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http://dx.doi.org/10.1093/ehjci/jes185DOI Listing
February 2013

[Giant left ventricular pseudoaneurysm: the diagnostic contribution of different non-invasive imaging modalities].

Rev Port Cardiol 2012 Jun;31(6):439-44

Serviço de Cardiologia, Hospital de São João, Porto, Portugal.

Distinguishing between ventricular aneurysm and pseudoaneurysm, although difficult, is of major importance due to the therapeutic and prognostic implications. The present case highlights the pivotal role of non-invasive imaging modalities for differential diagnosis between these entities in order to ensure appropriate management of these patients.
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http://dx.doi.org/10.1016/j.repc.2012.04.009DOI Listing
June 2012

[Hypocalcemia as a reversible cause of heart failure].

Rev Port Cardiol 2012 Jan 7;31(1):39-41. Epub 2011 Dec 7.

Serviço de Cardiologia, Hospital de S. João, Porto, Portugal.

Calcium plays a key role in heart muscle contraction and relaxation. Hypocalcemic heart failure is a rare and potentially reversible disturbance, which reflects this intrinsic relationship. The authors present the case of a 35-year-old woman who developed acute heart failure during the early postoperative period following total thyroidectomy. The echocardiogram showed severe global left ventricular dysfunction. Laboratory tests showed severe hypocalcemia and new-onset hypoparathyroidism. Cardiac catheterization showed angiographically normal coronary arteries. After clinical, hemodynamic and metabolic stabilization, a repeat echocardiogram revealed recovery of left ventricular function. Subsequently, cardiac magnetic resonance imaging was performed, which also showed no alterations. The patient was discharged asymptomatic, medicated with calcium carbonate, calcitriol and levothyroxine. This case highlights the importance of considering hypocalcemia as a cause of reversible myocardial dysfunction.
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http://dx.doi.org/10.1016/j.repc.2011.09.016DOI Listing
January 2012

Clinical significance of impaired relaxation pattern in middle-aged and elderly adults in the general population.

Rev Port Cardiol 2010 Dec;29(12):1799-806

Serviço de Higiene e Epidemiologia da Faculdade de Medicina da Universidade do Porto, Portugal.

Introduction: The prevalence of diastolic dysfunction in the general population is largely unknown. The purpose of this study was to assess the prevalence of impaired relaxation pattern with normal ejection fraction (IRPNEF) in a population health survey and to analyze associated characteristics.

Methods: This was a cross-sectional evaluation of 739 community participants aged 45 years or older, randomly selected from the general population. Subjects with left ventricular systolic dysfunction (ejection fraction < 45%), moderate or severe valvular disease or restrictive pattern were excluded, resulting in 653 individuals (age 61.4 +/- 10.3 years, 60.8% women). Diastolic dysfunction was classified according to transmitral inflow pulsed Doppler data.

Results: Overall, 215 (32.9%) had impaired relaxation. IRPNEF was associated with older age (p < 0.001), arterial hypertension (p < 0.001), diabetes (p = 0.03), coronary artery disease (p = 0.006) and metabolic syndrome (p = 0.014). The echocardiographic characteristics associated with IRPNRF were LV hypertrophy (p < 0.001) and left atrial diameter index (p = 0.008). No relation was found between IRPNEF and the clinical syndrome of heart failure or increased BNP level. Nevertheless, exertion dyspnea was more prevalent among subjects with IRPNEF (p = 0.004). In stratified analysis, arterial hypertension, metabolic syndrome and echocardiographic LV hypertrophy were associated with IRPNEF in subjects younger than 65 years, but not in the elderly. Among younger subjects, in multivariate logistic regression analysis, hypertension was a significant predictor of IRPNEF even when adjusting for LV hypertrophy (OR 2.23 [95% CI 1.33-3.73]).

Conclusions: We found a high prevalence of IRPNEF in the general population, in most cases unaccompanied by overt heart failure. IRPNEF was associated with hypertension in younger subjects but not in the elderly, in agreement with the concept that in older subjects it represents a physiologic phenomenon. IRPNEF was not associated with neurohumoral activation.
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December 2010

Anomalous origin of the left coronary artery from the pulmonary artery in an asymptomatic adult.

Congenit Heart Dis 2011 Jul-Aug;6(4):366-9. Epub 2011 Mar 10.

Departments of Cardiology Thoracic Surgery, Hospital São João, Porto, Portugal.

Anomalous origin of the left coronary artery from the pulmonary artery is a rare congenital anomaly with a mortality of 90% in the first year of life, if not surgically corrected. Adult presentation of the anomalous origin of the left coronary artery from the pulmonary artery syndrome is extremely rare but may occur if a well-developed collateral circulation from right coronary artery is present. We present the case of a 22-year-old asymptomatic female with anomalous origin of the left coronary artery from the pulmonary artery.
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http://dx.doi.org/10.1111/j.1747-0803.2010.00474.xDOI Listing
November 2011

Spontaneous closure of a left ventricle pseudoaneurysm following apical venting.

Eur J Echocardiogr 2011 Feb 25;12(2):E6. Epub 2010 Aug 25.

Serviço de Cardiologia, Hospital São João, E.P.E, Alameda Prof. Hernâni Monteiro, 4200-319 Porto, Portugal.

Cardiac surgery is the second most frequent aetiology of left ventricular pseudoaneurysm (LVP). Left ventricular apical venting is a recognized cause of LVP. Prompt surgical treatment is usually needed since there is a high risk of rupture and spontaneous closure is very rare. We describe a case of spontaneous closure of a left ventricle pseudoaneurysm following apical venting.
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http://dx.doi.org/10.1093/ejechocard/jeq102DOI Listing
February 2011

Cardiac Fabry's disease: an unusual cause of left ventricular hypertrophy.

Nat Clin Pract Cardiovasc Med 2007 Nov;4(11):630-3

Faculdade de Medicina do Porto, Alameda Prof Hernâni Monteiro, 4200 Porto, Portugal.

Background: A 64-year-old male was observed as an outpatient with atypical, non-exercise-induced chest pain and palpitations. He had arterial hypertension and marked concentric left ventricular hypertrophy. After 2.5 years of antihypertensive drug therapy the patient's blood pressure had returned to normal, but his left ventricular hypertrophy was unchanged.

Investigations: Electrocardiography, transthoracic echocardiography, myocardial perfusion scintigraphic imaging, measurement of alpha-galactosidase A activity, gene sequencing, brain MRI, carotid artery ultrasonography, biochemical renal evaluation and cardiac Doppler tissue imaging.

Diagnosis: Cardiac Fabry's disease.

Management: Losartan, hydrochlorothiazide, low-dose aspirin and bisoprolol. The patient is expected to begin enzyme replacement therapy.
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http://dx.doi.org/10.1038/ncpcardio1012DOI Listing
November 2007

Chronic left ventricular pseudoaneurism.

Rev Port Cardiol 2002 Dec;21(12):1481-5

Unidade de Cardiologia (Departamento de Medicina) e Serviço de Cirurgia Cardiotorácica, Hospital de S. João, Porto.

We present the case of a 70-year-old white male presenting with an abnormal cardiac silhouette on the chest X-ray and complaining of fatigue in the week before hospital admission. Four months before admission he had a single prolonged ischemic chest pain episode. The ECG revealed an old true posterior myocardial infarction. The transthoracic echocardiogram showed a large left ventricular pseudoaneurysm and surgical resection was performed successfully. The etiology, diagnosis and treatment of left ventricular pseudoaneurysm are reviewed.
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December 2002
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