Multiple left ventricular aneurysms in a young female | Revista Portuguesa de Cardiologia

array:25 ["pii" => "S0870255116000044" "issn" => "08702551" "doi" => "10.1016/j.repc.2015.09.020" "estado" => "S300" "fechaPublicacion" => "2016-02-01" "aid" => "763" "copyright" => "Sociedade Portuguesa de Cardiologia" "copyrightAnyo" => "2016" "documento" => "simple-article" "crossmark" => 1 "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/" "subdocumento" => "crp" "cita" => "Rev Port Cardiol. 2016;35:113.e1-6" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 4161 "formatos" => array:3 [ "EPUB" => 188 "HTML" => 3429 "PDF" => 544 ] ] "Traduccion" => array:1 [ "en" => array:20 [ "pii" => "S2174204916000283" "issn" => "21742049" "doi" => "10.1016/j.repce.2016.02.001" "estado" => "S300" "fechaPublicacion" => "2016-02-01" "aid" => "763" "copyright" => "Sociedade Portuguesa de Cardiologia" "documento" => "simple-article" "crossmark" => 1 "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/" "subdocumento" => "crp" "cita" => "Rev Port Cardiol. 2016;35:113.e1-6" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 3465 "formatos" => array:3 [ "EPUB" => 167 "HTML" => 2821 "PDF" => 477 ] ] "en" => array:13 [ "idiomaDefecto" => true "cabecera" => "Case report" "titulo" => "Multiple left ventricular aneurysms in a young female" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "en" 1 => "pt" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "113.e1" "paginaFinal" => "113.e6" ] ] "titulosAlternativos" => array:1 [ "pt" => array:1 [ "titulo" => "Múltiplos aneurismas do ventrículo esquerdo numa jovem" ] ] "contieneResumen" => array:2 [ "en" => true "pt" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 3264 "Ancho" => 2374 "Tamanyo" => 675419 ] ] "descripcion" => array:1 [ "en" => "Transthoracic two-dimensional echocardiogram with color Doppler. (A) Apical 4-chamber view in systole showing apical aneurysm (*); (B) parasternal long-axis view in diastole showing submitral aneurysm (**)." ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Abhishek P. Raval, Anand Shukla, Rajiv Garg, Yashpal Rana, Komal Shah" "autores" => array:5 [ 0 => array:2 [ "nombre" => "Abhishek P." "apellidos" => "Raval" ] 1 => array:2 [ "nombre" => "Anand" "apellidos" => "Shukla" ] 2 => array:2 [ "nombre" => "Rajiv" "apellidos" => "Garg" ] 3 => array:2 [ "nombre" => "Yashpal" "apellidos" => "Rana" ] 4 => array:2 [ "nombre" => "Komal" "apellidos" => "Shah" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S0870255116000044" "doi" => "10.1016/j.repc.2015.09.020" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0870255116000044?idApp=UINPBA00004E" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2174204916000283?idApp=UINPBA00004E" "url" => "/21742049/0000003500000002/v2_201703220311/S2174204916000283/v2_201703220311/en/main.assets" ] ] "itemSiguiente" => array:20 [ "pii" => "S0870255116000056" "issn" => "08702551" "doi" => "10.1016/j.repc.2015.06.013" "estado" => "S300" "fechaPublicacion" => "2016-02-01" "aid" => "764" "copyright" => "Sociedade Portuguesa de Cardiologia" "documento" => "simple-article" "crossmark" => 1 "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/" "subdocumento" => "crp" "cita" => "Rev Port Cardiol. 2016;35:115.e1-5" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 2867 "formatos" => array:3 [ "EPUB" => 198 "HTML" => 2139 "PDF" => 530 ] ] "en" => array:13 [ "idiomaDefecto" => true "cabecera" => "Case report" "titulo" => "Transcatheter device closure of pseudoaneurysms of the left ventricular wall: An emerging therapeutic option" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "en" 1 => "pt" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "115.e1" "paginaFinal" => "115.e5" ] ] "titulosAlternativos" => array:1 [ "pt" => array:1 [ "titulo" => "Tratamento percutâneo com dispositivo de oclusão de pseudoaneurisma do ventrículo esquerdo – uma alternativa terapêutica" ] ] "contieneResumen" => array:2 [ "en" => true "pt" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0020" "etiqueta" => "Figure 4" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr4.jpeg" "Alto" => 850 "Ancho" => 1500 "Tamanyo" => 217762 ] ] "descripcion" => array:1 [ "en" => "(A) and (B) Cardiac computed tomography performed after six months showing complete closure of the defect by Amplatzer septal occluder (arrows). The asterisks indicate partially thrombosed pseudoaneurysm." ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Tarun Madan, Manish Juneja, Abhishek Raval, Bhavesh Thakkar" "autores" => array:4 [ 0 => array:2 [ "nombre" => "Tarun" "apellidos" => "Madan" ] 1 => array:2 [ "nombre" => "Manish" "apellidos" => "Juneja" ] 2 => array:2 [ "nombre" => "Abhishek" "apellidos" => "Raval" ] 3 => array:2 [ "nombre" => "Bhavesh" "apellidos" => "Thakkar" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S2174204916000295" "doi" => "10.1016/j.repce.2015.07.019" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2174204916000295?idApp=UINPBA00004E" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0870255116000056?idApp=UINPBA00004E" "url" => "/08702551/0000003500000002/v1_201602130045/S0870255116000056/v1_201602130045/en/main.assets" ] "itemAnterior" => array:19 [ "pii" => "S0870255115003613" "issn" => "08702551" "doi" => "10.1016/j.repc.2015.09.016" "estado" => "S300" "fechaPublicacion" => "2016-02-01" "aid" => "757" "copyright" => "Sociedade Portuguesa de Cardiologia" "documento" => "article" "crossmark" => 1 "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/" "subdocumento" => "ssu" "cita" => "Rev Port Cardiol. 2016;35:105-12" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 5143 "formatos" => array:3 [ "EPUB" => 163 "HTML" => 4275 "PDF" => 705 ] ] "en" => array:13 [ "idiomaDefecto" => true "cabecera" => "Review article" "titulo" => "Coronary optical coherence tomography: A practical overview of current clinical applications" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "en" 1 => "pt" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "105" "paginaFinal" => "112" ] ] "titulosAlternativos" => array:1 [ "pt" => array:1 [ "titulo" => "Tomografia de coerência ótica coronária: uma revisão prática das aplicações clínicas atuais" ] ] "contieneResumen" => array:2 [ "en" => true "pt" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 1765 "Ancho" => 1625 "Tamanyo" => 320379 ] ] "descripcion" => array:1 [ "en" => "Optical coherence tomography revealing stent malapposition with a large distance between struts and vessel wall." ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Rui Cruz Ferreira, Tiago Pereira-da-Silva, Lino Patrício, Hiram Bezerra, Marco Costa" "autores" => array:5 [ 0 => array:2 [ "nombre" => "Rui" "apellidos" => "Cruz Ferreira" ] 1 => array:2 [ "nombre" => "Tiago" "apellidos" => "Pereira-da-Silva" ] 2 => array:2 [ "nombre" => "Lino" "apellidos" => "Patrício" ] 3 => array:2 [ "nombre" => "Hiram" "apellidos" => "Bezerra" ] 4 => array:2 [ "nombre" => "Marco" "apellidos" => "Costa" ] ] ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0870255115003613?idApp=UINPBA00004E" "url" => "/08702551/0000003500000002/v1_201602130045/S0870255115003613/v1_201602130045/en/main.assets" ] "en" => array:19 [ "idiomaDefecto" => true "cabecera" => "Case report" "titulo" => "Multiple left ventricular aneurysms in a young female" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "113.e1" "paginaFinal" => "113.e6" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Abhishek P. Raval, Anand Shukla, Rajiv Garg, Yashpal Rana, Komal Shah" "autores" => array:5 [ 0 => array:4 [ "nombre" => "Abhishek P." "apellidos" => "Raval" "email" => array:1 [ 0 => "docabs4u@gmail.com" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "*" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "Anand" "apellidos" => "Shukla" ] 2 => array:2 [ "nombre" => "Rajiv" "apellidos" => "Garg" ] 3 => array:2 [ "nombre" => "Yashpal" "apellidos" => "Rana" ] 4 => array:2 [ "nombre" => "Komal" "apellidos" => "Shah" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "U.N. Mehta Institute of Cardiology and Research Centre (UNMICRC), Ahmedabad, India" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "pt" => array:1 [ "titulo" => "Múltiplos aneurismas do ventrículo esquerdo numa jovem" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0020" "etiqueta" => "Figure 4" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr4.jpeg" "Alto" => 1455 "Ancho" => 3201 "Tamanyo" => 286203 ] ] "descripcion" => array:1 [ "en" => "Cardiac magnetic resonance imaging. (A) Bright-blood image showing apical aneurysm (white arrow) and submitral aneurysm (red arrow) in vertical long-axis view; (B) bright-blood image showing apical aneurysm (white arrow) and anterior aneurysm (yellow arrow) in 4-chamber view." ] ] ] "textoCompleto" => "IntroductionLeft ventricular aneurysm (LVA) is usually defined as a segment of the ventricular wall that exhibits paradoxical systolic expansion; the term is generally reserved for a discrete, dyskinetic area of the left ventricular (LV) wall with a broad neck.<a class="elsevierStyleCrossRefs" href="#bib0190">1,2</a> It most frequently develops after myocardial infarction (MI).<a class="elsevierStyleCrossRef" href="#bib0200">3</a> However, other causes may be infectious, inflammatory, metabolic or autoimmune in nature. Multiple idiopathic LVAs are distinctly unusual and rarely reported. The clinical spectrum ranges from asymptomatic to congestive heart failure (CHF) to life-threatening ventricular arrhythmias and cardiac arrest.<a class="elsevierStyleCrossRefs" href="#bib0200">3,4</a> Herein, we report the case of a young female with multiple large LVAs, managed conservatively in the absence of overt CHF, arrhythmias and embolism, with excellent outcome.Case reportA 29-year-old woman presented with easy fatigability and chest discomfort for several months. These symptoms were insidious in onset and progressed little. There was no history of palpitations, syncope or dyspnea. She was hemodynamically stable with diffuse apex beat shifted downward and outward. The chest radiograph showed calcified LV apical and basal aneurysms. The electrocardiogram showed no pathological Q waves and normal precordial R-wave progression (<a class="elsevierStyleCrossRef" href="#fig0005">Figure 1</a>). Two-dimensional transthoracic echocardiography (iE33 xMATRIX, Philips Healthcare, Andover, MA, USA) showed moderate LV dysfunction; multiple LVAs (large apical aneurysm, moderate sized submitral aneurysm, and basal anterior aneurysm); normal contractility of the rest of the LV wall; and normal valves, other chambers and great vessels (<a class="elsevierStyleCrossRef" href="#fig0010">Figure 2</a>). The echocardiogram showed continuity of the myocardium of the aneurysms with the rest of the myocardium. Color flow Doppler showed flow in and out of the aneurysms.<elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia>The coronary angiogram (Philips Medical Systems, Nederland B.V.) showed normal epicardial coronaries. Catheterization showed LV pressure of 114/3 mmHg. Systemic and pulmonary arterial, right atrial and ventricular pressures were also normal. The left ventriculogram showed a large LV apical aneurysm with a heavily calcified thrombosed distal part, a large aneurysm of the basal anterior wall with a smooth and calcified distal part, and a moderate sized submitral aneurysm. All the aneurysms had large necks, poor contractility and paradoxical systolic filling. Contrast clearance was slightly delayed by a beat (<a class="elsevierStyleCrossRef" href="#fig0015">Figure 3</a>).<elsevierMultimedia ident="fig0015"></elsevierMultimedia>To further evaluate LV function and anatomy and the shape of the aneurysms and to differentiate between true and pseudoaneurysms, magnetic resonance imaging (MRI) (Achieva 1.5 T system, Philips Healthcare, Andover, USA) was performed. Using a dedicated cardiac coil, images were acquired with electrocardiographic gating and balanced turbo field echo/fast field echo in short-axis, vertical long-axis, 4-chamber and transverse planes, followed by perfusion studies and delayed contrast-enhanced imaging. These showed LV ejection fraction of 39.5% and stroke volume of 55.4 ml. Images were analyzed for the location of aneurysms, maximal internal width of the orifice, and maximal parallel internal diameter. The largest outpouching on the anterolateral wall of the LV showed thinning of the overlying myocardium (thickness 3.5 mm). The neck and maximum diameter were both 24 mm and the ratio of maximal internal width of the orifice and maximal parallel internal diameter was 1.0. There was no delayed pericardial enhancement. All these findings suggested that this was a true aneurysm. Other aneurysms on the anterior wall and submitral area were smaller and had similar characteristics (<a class="elsevierStyleCrossRef" href="#fig0020">Figure 4</a>). MRI ruled out inflammatory and infiltrative disorders.<elsevierMultimedia ident="fig0020"></elsevierMultimedia>The patient denied a history of rheumatic or systemic diseases, toxin exposure or chest trauma. There was no involvement of skin, mucosa or other organ systems. Family history was insignificant for CHF, cardiomyopathy, arrhythmias or sudden cardiac death. Serum levels of inflammatory markers (erythrocyte sedimentation rate and C-reactive protein), cardiac biomarkers and serum protein electrophoresis were normal. Investigations for Chagas disease, syphilis, sarcoidosis, tuberculosis, connective tissue diseases, and human immunodeficiency virus (HIV) were negative. Holter monitoring performed to screen for ventricular extrasystoles and tachyarrhythmias was normal. Abdominal ultrasound showed normal liver and kidneys.Considering the idiopathic nature of the aneurysms and the absence of overt decompensated CHF, angina, arrhythmias and embolism, the patient was considered for medical management in the form of beta-blockers to prevent arrhythmias and warfarin to prevent systemic embolism. At 18 months of follow-up she was free of CHF, arrhythmias and embolism.DiscussionLVAs are usually classified as congenital or acquired, i.e. arising from a cardiac or non-cardiac disorder.<a class="elsevierStyleCrossRef" href="#bib0200">3</a> Acquired LVAs most frequently result from MI<a class="elsevierStyleCrossRefs" href="#bib0200">3,5</a> or coronary artery malformations such as fistulas.<a class="elsevierStyleCrossRef" href="#bib0215">6</a> They may also be present in arrhythmogenic right ventricular cardiomyopathy,<a class="elsevierStyleCrossRef" href="#bib0220">7</a> hypertrophic cardiomyopathy,<a class="elsevierStyleCrossRef" href="#bib0225">8</a> and myocarditis.<a class="elsevierStyleCrossRef" href="#bib0230">9</a> Underlying non-cardiac systemic diseases include sarcoidosis,<a class="elsevierStyleCrossRef" href="#bib0235">10</a> Chagas disease,<a class="elsevierStyleCrossRef" href="#bib0240">11</a> lupus erythematosus,<a class="elsevierStyleCrossRef" href="#bib0245">12</a> Behcet's disease,<a class="elsevierStyleCrossRef" href="#bib0250">13</a> tuberculosis,<a class="elsevierStyleCrossRef" href="#bib0205">4</a> syphilis<a class="elsevierStyleCrossRef" href="#bib0255">14</a> or HIV.<a class="elsevierStyleCrossRef" href="#bib0260">15</a> As a rare complication, LVAs have also been observed in glycogen storage diseases,<a class="elsevierStyleCrossRef" href="#bib0265">16</a> hyperimmunoglobulin-E syndrome<a class="elsevierStyleCrossRef" href="#bib0270">17</a> and blunt chest trauma.<a class="elsevierStyleCrossRef" href="#bib0275">18</a> Congenital LVAs (occurring in the perinatal period) have been detected as early as the second trimester of gestation<a class="elsevierStyleCrossRef" href="#bib0280">19</a> and have been associated with severe comorbidities and intrauterine death. Idiopathic LVAs (without an identifiable underlying cause) are rare.<a class="elsevierStyleCrossRefs" href="#bib0200">3,20</a> Weakness of the LV wall, with herniation of the endocardium under the influence of ventricular pressure, and resulting in the formation of a fibrous walled aneurysm with calcium and thrombus deposits in its walls, sometimes with adhesions to the adjacent pericardium, has been suggested as the underlying pathogenesis.<a class="elsevierStyleCrossRef" href="#bib0290">21</a> Idiopathic submitral LVA, of non-ischemic origin, a rare entity, is commonly described in young black Africans and sometimes in Caucasians.<a class="elsevierStyleCrossRef" href="#bib0295">22</a> The higher prevalence in certain ethnic groups and the absence of a clear etiology suggest a congenital etiology.<a class="elsevierStyleCrossRef" href="#bib0295">22</a> Idiopathic LVA appears to be caused by an abnormality in the junction between the cardiac muscle and the fibrous structure of the heart. It can vary in size from millimeters to several centimeters.<a class="elsevierStyleCrossRef" href="#bib0295">22</a> These are anatomically distinct from congenital diverticula, which are defined as having only a narrow communication with the ventricle.<a class="elsevierStyleCrossRef" href="#bib0260">15</a> Multiple idiopathic LVAs are distinctly unusual and are rarely reported.As with aneurysms of atherosclerotic origin, these entities may be associated with a variety of symptoms, including chest discomfort,<a class="elsevierStyleCrossRef" href="#bib0285">20</a> ventricular tachyarrhythmias leading to sudden cardiac death,<a class="elsevierStyleCrossRef" href="#bib0200">3</a> angina,<a class="elsevierStyleCrossRef" href="#bib0300">23</a> CHF,<a class="elsevierStyleCrossRef" href="#bib0205">4</a> or recurrent thromboembolism.<a class="elsevierStyleCrossRef" href="#bib0285">20</a> The tissue of the LVA has been described as inhomogeneous, with viable, normal myocytes, fibrotic tissue, and/or hypertrophic myocytes.<a class="elsevierStyleCrossRefs" href="#bib0200">3,4,24</a> This may well represent an arrhythmogenic substrate due to local conduction delay and dispersion of excitability and refractoriness, which may be augmented by catecholamines during exercise or mental stress.<a class="elsevierStyleCrossRef" href="#bib0310">25</a> A study has demonstrated that inflammatory LV microaneurysms, often of viral origin, can be a cause of idiopathic ventricular tachyarrhythmias.<a class="elsevierStyleCrossRef" href="#bib0315">26</a> In addition, large aneurysms interfere with LV performance through loss of contractile tissue due to mixture of scar tissue and viable myocardium and also by a paradoxical expansion,<a class="elsevierStyleCrossRef" href="#bib0190">1</a> leading to CHF.LVAs have been depicted and characterized by various imaging modalities.<a class="elsevierStyleCrossRef" href="#bib0200">3</a> Radionuclide ventriculography and echocardiography can demonstrate LVAs more readily.<a class="elsevierStyleCrossRef" href="#bib0190">1</a> A definitive diagnosis of LVA is best made non-invasively by echocardiography, which also helps in distinguishing a true from a pseudoaneurysm based on the demonstration of a narrow neck in relation to cavity size in the latter.<a class="elsevierStyleCrossRef" href="#bib0320">27</a> The myocardium surrounding a true aneurysm is in continuity with the rest of the myocardium, as in our case, while there is no myocardium around a pseudoaneurysm, leading to a breach in the continuity of the normal myocardium.<a class="elsevierStyleCrossRef" href="#bib0325">28</a> An abrupt discontinuity of the endocardial image between the aneurysm and adjacent normal myocardium is a characteristic finding with a pseudoaneurysm.<a class="elsevierStyleCrossRef" href="#bib0255">14</a> True and pseudoaneurysms can both be non-contractile or dyskinetic and may contain thrombus.<a class="elsevierStyleCrossRefs" href="#bib0325">28,29</a> Color flow Doppler is useful in establishing the diagnosis as flow in and out of the aneurysm, as well as abnormal flow within it, can be detected. Pulsed Doppler imaging can reveal a to-and-fro pattern with characteristic respiratory variation in peak systolic velocity.<a class="elsevierStyleCrossRef" href="#bib0190">1</a> However, echocardiography has the limitation of occasional failure to define the neck.<a class="elsevierStyleCrossRef" href="#bib0335">30</a>Left ventriculography is another potential tool that can detect an abnormal bulge or dyskinetic wall motion in the LV contour during systole; however, it is an invasive method. True aneurysms have a wider neck, as in our case, in contrast to the narrow neck of a pseudoaneurysm.<a class="elsevierStyleCrossRefs" href="#bib0340">31,32</a> Contrast remains within the cavity of the pseudoaneurysm for several beats after injection.<a class="elsevierStyleCrossRefs" href="#bib0340">31,32</a> Coronary arteries can extend on the aneurysmal wall in a true aneurysm, while, in a pseudoaneurysm with disrupted myocardium, a cavity is created by blood and pericardium and the coronaries do not drape over this paraventricular chamber.<a class="elsevierStyleCrossRef" href="#bib0345">32</a> A true aneurysm is less likely than a pseudoaneurysm to be secondary to MI, leading to abnormal patency of at least one of the coronary arteries. Other clues include a characteristic bulge and calcified LV silhouette on the chest radiograph, which is a specific finding but not sensitive.<a class="elsevierStyleCrossRef" href="#bib0190">1</a> The presence of a discrete bulge anteriorly is more in favor of a true aneurysm.<a class="elsevierStyleCrossRef" href="#bib0335">30</a> In the case of a pseudoaneurysm, the chest X-ray may show a pericardial mass with a characteristic notch at the border of the mass.<a class="elsevierStyleCrossRef" href="#bib0255">14</a> In our case, by contrast, the borders were relatively smooth and a bulge was present anteriorly.Recently, MRI has emerged as the preferred non-invasive technique for assessment of LV shape, the degree of aneurysm thinning, and resectability.<a class="elsevierStyleCrossRefs" href="#bib0350">33,34</a> MRI can distinguish between pericardium, thrombus, and myocardium, which are not easily distinguished by contrast ventriculography,<a class="elsevierStyleCrossRef" href="#bib0335">30</a> and helps resolve uncertainty between a true and a pseudoaneurysm. Contrast-enhanced MRI provides additional information on myocardial tissue characteristics, perfusion, and viability.<a class="elsevierStyleCrossRef" href="#bib0200">3</a> In the case of a true aneurysm, the tissue making up the wall of the aneurysm shows delayed myocardial enhancement. As the wall of a pseudoaneurysm is composed only of pericardium, it shows no delayed myocardial enhancement; however, its border does show enhancement.<a class="elsevierStyleCrossRef" href="#bib0335">30</a> Pseudoaneurysms may show delayed pericardial enhancement.<a class="elsevierStyleCrossRef" href="#bib0330">29</a> The ratio of maximal internal width of the orifice and maximal parallel internal diameter of 1.0 and the absence of delayed pericardial enhancement confirmed the aneurysms as true ones in the case presented.<a class="elsevierStyleCrossRef" href="#bib0330">29</a> To elucidate the pathogenesis further, radionuclide imaging techniques can be used to assess myocardial viability (2-[fluorine-18]fluoro-2-deoxy-D-glucose positron emission tomography) and regional sympathetic innervation ([iodine-123]metaiodobenzylguanidine single photon emission computed tomography).<a class="elsevierStyleCrossRef" href="#bib0200">3</a> Endomyocardial biopsy can demonstrate myocarditis, sarcoidosis, arrhythmogenic right ventricular cardiomyopathy, or storage disease.<a class="elsevierStyleCrossRef" href="#bib0200">3</a> Programmed ventricular stimulation can help to induce clinically silent arrhythmias.<a class="elsevierStyleCrossRef" href="#bib0200">3</a> As there was no history suggestive of hemodynamically significant arrhythmias, we assessed our patient with Holter monitoring only.Treatment and prognosis of idiopathic LVAs are dependent on their size, location, and degree of valvular involvement, CHF functional class, and presence of ventricular tachyarrhythmias.<a class="elsevierStyleCrossRef" href="#bib0200">3</a> Management strategies therefore range from antiarrhythmic drugs<a class="elsevierStyleCrossRef" href="#bib0360">35</a> to ablation for ventricular tachycardia,<a class="elsevierStyleCrossRef" href="#bib0365">36</a> implantation of a cardioverter-defibrillator,<a class="elsevierStyleCrossRef" href="#bib0305">24</a> treatment of CHF<a class="elsevierStyleCrossRef" href="#bib0200">3</a> or (less frequently) surgical aneurysmectomy.<a class="elsevierStyleCrossRef" href="#bib0370">37</a> The latter is carried out to improve clinical manifestations, mostly CHF but sometimes also angina, embolization, and life-threatening tachyarrhythmias.<a class="elsevierStyleCrossRef" href="#bib0190">1</a> However, prospective long-term follow-up studies comparing the different strategies are not available.<a class="elsevierStyleCrossRef" href="#bib0200">3</a> Our patient was successfully managed with beta-blockers to prevent arrhythmias and oral anticoagulants to prevent thromboembolism. Idiopathic multiple LVAs in a young female demonstrated on ventriculography were reported to be treated conservatively with medical therapy with acceptable clinical course and without adverse clinical sequelae.<a class="elsevierStyleCrossRef" href="#bib0285">20</a>ConclusionMultiple LVAs in a patient can be idiopathic in nature and have varied presentations. They can be managed conservatively in the absence of angina, decompensated CHF and tachyarrhythmias.Ethical disclosuresProtection of human and animal subjectsThe authors declare that no experiments were performed on humans or animals for this study.Confidentiality of dataThe authors declare that no patient data appear in this article.Right to privacy and informed consentThe authors have obtained the written informed consent of the patients or subjects mentioned in the article. The corresponding author is in possession of this document.Conflicts of interestThe authors have no conflicts of interest to declare." "textoCompletoSecciones" => array:1 [ "secciones" => array:11 [ 0 => array:3 [ "identificador" => "xres604829" "titulo" => "Abstract" "secciones" => array:1 [ 0 => array:1 [ "identificador" => "abst0005" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec618935" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres604830" "titulo" => "Resumo" "secciones" => array:1 [ 0 => array:1 [ "identificador" => "abst0010" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec618934" "titulo" => "Palavras-chave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:2 [ "identificador" => "sec0010" "titulo" => "Case report" ] 6 => array:2 [ "identificador" => "sec0015" "titulo" => "Discussion" ] 7 => array:2 [ "identificador" => "sec0020" "titulo" => "Conclusion" ] 8 => array:3 [ "identificador" => "sec0025" "titulo" => "Ethical disclosures" "secciones" => array:3 [ 0 => array:2 [ "identificador" => "sec0030" "titulo" => "Protection of human and animal subjects" ] 1 => array:2 [ "identificador" => "sec0035" "titulo" => "Confidentiality of data" ] 2 => array:2 [ "identificador" => "sec0040" "titulo" => "Right to privacy and informed consent" ] ] ] 9 => array:2 [ "identificador" => "sec0045" "titulo" => "Conflicts of interest" ] 10 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2014-11-18" "fechaAceptado" => "2015-09-02" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec618935" "palabras" => array:6 [ 0 => "Chest radiograph" 1 => "Coronary angiogram" 2 => "Cardiac catheterization" 3 => "Ventriculogram" 4 => "Cardiac magnetic resonance imaging" 5 => "Aneurysm" ] ] ] "pt" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palavras-chave" "identificador" => "xpalclavsec618934" "palabras" => array:6 [ 0 => "Radiografia de tórax" 1 => "Angiografia coronária" 2 => "Cateterismo cardíaco" 3 => "Ecografia ventricular" 4 => "Ressonância magnética cardíaca" 5 => "Aneurisma" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:2 [ "titulo" => "Abstract" "resumen" => "Multiple left ventricular aneurysms (LVAs) are rare, especially in a young female. A 29-year-old woman presented vague symptoms. Multiple LVAs were revealed and confirmed on different imaging modalities, including chest radiography, echocardiography, contrast ventriculography and cardiac magnetic resonance imaging. Detailed work-up for probable etiologies including ischemic, infectious, inflammatory and autoimmune causes was negative. In the absence of angina, decompensated congestive heart failure, arrhythmias and embolism, the patient was managed conservatively, with excellent mid-term outcome." ] "pt" => array:2 [ "titulo" => "Resumo" "resumen" => "Múltiplos aneurismas no ventrículo esquerdo (MAVE) são uma situação rara em especial numa jovem que apresentou queixas vagas. Vários MAVE foram revelados e confirmados em diferentes modalidades de imagem. A doente submeteu-se a radiografia de tórax, ecocardiografia, ecografia de contraste e ressonância magnética cardíaca. A investigação minuciosa de etiologias isquémica, infecciosa, inflamatória e autoimune foi negativa. Dada a ausência de angina, insuficiência cardíaca congestiva, arritmias e embolia, a doente foi tratada de forma conservadora apresentando um excelente prognóstico a médio prazo." ] ] "multimedia" => array:4 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1433 "Ancho" => 3285 "Tamanyo" => 817954 ] ] "descripcion" => array:1 [ "en" => "(A) Chest radiograph in posteroanterior view showing large calcified left ventricular apical aneurysm (*) and basal aneurysm (**); (B) electrocardiogram showing no pathological Q waves and normal progression of precordial R wave." ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1958 "Ancho" => 1424 "Tamanyo" => 322165 ] ] "descripcion" => array:1 [ "en" => "Transthoracic two-dimensional echocardiogram with color Doppler. (A) Apical 4-chamber view in systole showing apical aneurysm (*); (B) parasternal long-axis view in diastole showing submitral aneurysm (**)." ] ] 2 => array:7 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 1503 "Ancho" => 2891 "Tamanyo" => 294638 ] ] "descripcion" => array:1 [ "en" => "Left ventriculogram. (A) Right anterior oblique view in diastole showing apical aneurysm (*), basal anterior aneurysm (**), submitral aneurysm (***) and normal left coronary artery branches (arrow); (B) lateral view in diastole showing LV apical aneurysm (*), basal anterior aneurysm (**) and normal left coronary artery branches (arrow)." ] ] 3 => array:7 [ "identificador" => "fig0020" "etiqueta" => "Figure 4" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr4.jpeg" "Alto" => 1455 "Ancho" => 3201 "Tamanyo" => 286203 ] ] "descripcion" => array:1 [ "en" => "Cardiac magnetic resonance imaging. (A) Bright-blood image showing apical aneurysm (white arrow) and submitral aneurysm (red arrow) in vertical long-axis view; (B) bright-blood image showing apical aneurysm (white arrow) and anterior aneurysm (yellow arrow) in 4-chamber view." ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:37 [ 0 => array:3 [ "identificador" => "bib0190" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Stable ischemic heart disease" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "D.A. Morrow" 1 => "W.E. Boden" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "LibroEditado" => array:5 [ "titulo" => "Braunwald's heart disease: a textbook of cardiovascular medicine" "paginaInicial" => "1182" "paginaFinal" => "1244" "edicion" => "10th ed." "serieFecha" => "2014" ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0195" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "ST-elevation myocardial infarction: management" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "J.L. Mega" 1 => "D.A. Morrow" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "LibroEditado" => array:5 [ "titulo" => "Braunwald's heart disease: a textbook of cardiovascular medicine" "paginaInicial" => "1095" "paginaFinal" => "1154" "edicion" => "10th ed." "serieFecha" => "2014" ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0200" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Idiopathic left ventricular aneurysm and sudden cardiac death in young adults" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "M. Paul" 1 => "M. Schäfers" 2 => "M. Grude" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1093/europace/eul074" "Revista" => array:6 [ "tituloSerie" => "Europace" "fecha" => "2006" "volumen" => "8" "paginaInicial" => "607" "paginaFinal" => "612" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16864613" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0205" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Congenital left ventricular aneurysm: clinical, imaging, pathologic, and surgical findings in seven new cases" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "J. Papagiannis" 1 => "R. Van Praagh" 2 => "O. Schwint" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1067/mhj.2001.113076" "Revista" => array:6 [ "tituloSerie" => "Am Heart J" "fecha" => "2001" "volumen" => "141" "paginaInicial" => "491" "paginaFinal" => "499" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11231449" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0210" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Left ventricular aneurysm formation after anterior myocardial infarction: clinical and angiographic determinants in 809 patients" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "H. Tikiz" 1 => "R. Atak" 2 => "Y. Balbay" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Int J Cardiol" "fecha" => "2002" "volumen" => "82" "paginaInicial" => "7" "paginaFinal" => "14" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11786151" "web" => "Medline" ] ] ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0215" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Right coronary artery to left ventricular fistula associated with left ventricular aneurysm" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "N. Atsumi" 1 => "H. Horigome" 2 => "W. Mihara" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1007/s002469910031" "Revista" => array:6 [ "tituloSerie" => "Pediatr Cardiol" "fecha" => "2000" "volumen" => "21" "paginaInicial" => "172" "paginaFinal" => "174" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10754093" "web" => "Medline" ] ] ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib0220" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Evolution of left ventricular involvement in arrhythmogenic right ventricular cardiomyopathy" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "M. Horimoto" 1 => "M. Akino" 2 => "T. Takenaka" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "7026" "Revista" => array:6 [ "tituloSerie" => "Cardiology" "fecha" => "2000" "volumen" => "93" "paginaInicial" => "197" "paginaFinal" => "200" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10965092" "web" => "Medline" ] ] ] ] ] ] ] ] 7 => array:3 [ "identificador" => "bib0225" "etiqueta" => "8" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Hypertrophic cardiomyopathy with apical left ventricular aneurysm" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "Y. Akutsu" 1 => "A. Shinozuka" 2 => "T.Y. Huang" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Jpn Circ J" "fecha" => "1998" "volumen" => "62" "paginaInicial" => "127" "paginaFinal" => "131" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/9559432" "web" => "Medline" ] ] ] ] ] ] ] ] 8 => array:3 [ "identificador" => "bib0230" "etiqueta" => "9" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Prognostic significance of left ventricular aneurysm with normal global function caused by myocarditis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "A. Frustaci" 1 => "C. Chimenti" 2 => "M. Pieroni" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Chest" "fecha" => "2000" "volumen" => "118" "paginaInicial" => "1696" "paginaFinal" => "1702" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11115461" "web" => "Medline" ] ] ] ] ] ] ] ] 9 => array:3 [ "identificador" => "bib0235" "etiqueta" => "10" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Left ventricular apical aneurysm in cardiac sarcoidosis" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "H. Kosuge" 1 => "M. Noda" 2 => "T. Kakuta" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Jpn Heart J" "fecha" => "2001" "volumen" => "42" "paginaInicial" => "265" "paginaFinal" => "269" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11384087" "web" => "Medline" ] ] ] ] ] ] ] ] 10 => array:3 [ "identificador" => "bib0240" "etiqueta" => "11" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Chronic Chagas’ heart disease in a Japanese-Brazilian traveller. A case report" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "M. Takeno" 1 => "S. Seto" 2 => "F. Kawahara" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Jpn Heart J" "fecha" => "1999" "volumen" => "40" "paginaInicial" => "375" "paginaFinal" => "382" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10506860" "web" => "Medline" ] ] ] ] ] ] ] ] 11 => array:3 [ "identificador" => "bib0245" "etiqueta" => "12" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Acute myocarditis and left ventricular aneurysm as presentations of systemic lupus erythematosus" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "A. Frustaci" 1 => "N. Gentiloni" 2 => "M. Caldarulo" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Chest" "fecha" => "1996" "volumen" => "109" "paginaInicial" => "282" "paginaFinal" => "284" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/8549201" "web" => "Medline" ] ] ] ] ] ] ] ] 12 => array:3 [ "identificador" => "bib0250" "etiqueta" => "13" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Behcet's syndrome with left ventricular aneurysm and ruptured renal artery pseudoaneurysm" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "K. Han" 1 => "R. Siegel" 2 => "A.J. Pantuck" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Urology" "fecha" => "1999" "volumen" => "54" "paginaInicial" => "162" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10754656" "web" => "Medline" ] ] ] ] ] ] ] ] 13 => array:3 [ "identificador" => "bib0255" "etiqueta" => "14" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Left ventricular aneurysm: a review" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "H.A. Ba’albaki" 1 => "S.D. Clements Jr." ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Clin Cardiol" "fecha" => "1989" "volumen" => "12" "paginaInicial" => "5" "paginaFinal" => "13" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/2643491" "web" => "Medline" ] ] ] ] ] ] ] ] 14 => array:3 [ "identificador" => "bib0260" "etiqueta" => "15" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Left ventricular aneurysm in human immunodeficiency virus infection: a case report" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "A. Kane" 1 => "L. Hane" 2 => "J.M. Dangou" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Arch Mal Coeur Vaiss" "fecha" => "1998" "volumen" => "91" "paginaInicial" => "419" "paginaFinal" => "423" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/9749229" "web" => "Medline" ] ] ] ] ] ] ] ] 15 => array:3 [ "identificador" => "bib0265" "etiqueta" => "16" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Glycogen storage disease associated with left ventricular aneurysm in an elderly patient" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "G. Toda" 1 => "T. Yoshimuta" 2 => "H. Kawano" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Jpn Circ J" "fecha" => "2001" "volumen" => "65" "paginaInicial" => "462" "paginaFinal" => "464" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11348054" "web" => "Medline" ] ] ] ] ] ] ] ] 16 => array:3 [ "identificador" => "bib0270" "etiqueta" => "17" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Ventricular aneurysm and myocarditis in a child with hyperimmunoglobulin E syndrome" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "I.B. El Noor" 1 => "P. Venugopalan" 2 => "W.J. Johnston" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Eur Heart J" "fecha" => "1995" "volumen" => "16" "paginaInicial" => "714" "paginaFinal" => "715" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/7588908" "web" => "Medline" ] ] ] ] ] ] ] ] 17 => array:3 [ "identificador" => "bib0275" "etiqueta" => "18" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Coronary milking-like effect caused by systolic expansion of a traumatic focal left ventricular aneurysm" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "V. Marti" 1 => "J. Garcia" 2 => "J. MaAuge" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Heart" "fecha" => "2001" "volumen" => "85" "paginaInicial" => "622" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11359738" "web" => "Medline" ] ] ] ] ] ] ] ] 18 => array:3 [ "identificador" => "bib0280" "etiqueta" => "19" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Prenatal diagnosis of left ventricular aneurysm in the late second trimester: a case report" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "S.J. Sherman" 1 => "K.H. Leenhouts" 2 => "G.O. Utter" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1046/j.1469-0705.1996.07060456.x" "Revista" => array:6 [ "tituloSerie" => "Ultrasound Obstet Gynecol" "fecha" => "1996" "volumen" => "7" "paginaInicial" => "456" "paginaFinal" => "457" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/8807767" "web" => "Medline" ] ] ] ] ] ] ] ] 19 => array:3 [ "identificador" => "bib0285" "etiqueta" => "20" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Multiple idiopathic left ventricular aneurysms in a Japanese woman" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "G.A. Harris Jr." 1 => "A.K. Wong" 2 => "D.A. Lantz" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Mil Med" "fecha" => "1999" "volumen" => "164" "paginaInicial" => "448" "paginaFinal" => "450" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10377718" "web" => "Medline" ] ] ] ] ] ] ] ] 20 => array:3 [ "identificador" => "bib0290" "etiqueta" => "21" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Annular subvalvular left ventricular aneurysms in the South African Bantu" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "E. Chesler" 1 => "N. Joffe" 2 => "L. Schamroth" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Circulation" "fecha" => "1965" "volumen" => "32" "paginaInicial" => "43" "paginaFinal" => "51" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/14314490" "web" => "Medline" ] ] ] ] ] ] ] ] 21 => array:3 [ "identificador" => "bib0295" "etiqueta" => "22" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Idiopathic left ventricle aneurysm" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "G.R. Molina" 1 => "S.A. Zakzuk" 2 => "M. Vieira" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Arq Bras Cardiol: imagem cardiovasc" "fecha" => "2014" "volumen" => "27" "paginaInicial" => "105" "paginaFinal" => "108" ] ] ] ] ] ] 22 => array:3 [ "identificador" => "bib0300" "etiqueta" => "23" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Idiopathic subvalvular aneurysm of the left ventricle. Anatomical, clinical and developmental characteristics. Apropos of 13 cases" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "C. Bouramoue" 1 => "J.L. Nkoua" 2 => "T. Gombet" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Ann Cardiol Angeiol (Paris)" "fecha" => "1995" "volumen" => "44" "paginaInicial" => "7" "paginaFinal" => "13" ] ] ] ] ] ] 23 => array:3 [ "identificador" => "bib0305" "etiqueta" => "24" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Idiopathic aneurysm of the left ventricle. Apropos of 4 cases operated on with success" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "A. Rimailho" 1 => "C. Cabrol" 2 => "R. Soyer" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Arch Mal Coeur Vaiss" "fecha" => "1981" "volumen" => "74" "paginaInicial" => "443" "paginaFinal" => "451" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/6786242" "web" => "Medline" ] ] ] ] ] ] ] ] 24 => array:3 [ "identificador" => "bib0310" "etiqueta" => "25" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Modulation of drug effects by regional sympathetic denervation and supersensitivity" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "M.S. Stanton" 1 => "D.P. Zipes" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Circulation" "fecha" => "1991" "volumen" => "84" "paginaInicial" => "1709" "paginaFinal" => "1714" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/1914110" "web" => "Medline" ] ] ] ] ] ] ] ] 25 => array:3 [ "identificador" => "bib0315" "etiqueta" => "26" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Inflammatory left ventricular microaneurysms as a cause of apparently idiopathic ventricular tachyarrhythmias" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "C. Chimenti" 1 => "F. Calabrese" 2 => "G. Thiene" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Circulation" "fecha" => "2001" "volumen" => "104" "paginaInicial" => "168" "paginaFinal" => "173" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11447081" "web" => "Medline" ] ] ] ] ] ] ] ] 26 => array:3 [ "identificador" => "bib0320" "etiqueta" => "27" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Tomographic three-dimensional echocardiographic determination of chamber size and systolic function in patients with left ventricular aneurysm: comparison to magnetic resonance imaging, cineventriculography, and two-dimensional echocardiography" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "T. Buck" 1 => "P. Hunold" 2 => "K.U. Wentz" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Circulation" "fecha" => "1997" "volumen" => "96" "paginaInicial" => "4286" "paginaFinal" => "4297" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/9416895" "web" => "Medline" ] ] ] ] ] ] ] ] 27 => array:3 [ "identificador" => "bib0325" "etiqueta" => "28" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Diagnosing left ventricular aneurysm from pseudo-aneurysm: a case report and a review in literature" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "G. Zoffoli" 1 => "D. Mangino" 2 => "A. Venturini" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1186/1749-8090-4-11" "Revista" => array:5 [ "tituloSerie" => "J Cardiothorac Surg" "fecha" => "2009" "volumen" => "4" "paginaInicial" => "11" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19239694" "web" => "Medline" ] ] ] ] ] ] ] ] 28 => array:3 [ "identificador" => "bib0330" "etiqueta" => "29" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "True versus false left ventricular aneurysm: differentiation with MR imaging – initial experience" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "E. Konen" 1 => "N. Merchant" 2 => "C. Gutierrez" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1148/radiol.2361031699" "Revista" => array:6 [ "tituloSerie" => "Radiology" "fecha" => "2005" "volumen" => "236" "paginaInicial" => "65" "paginaFinal" => "70" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15955851" "web" => "Medline" ] ] ] ] ] ] ] ] 29 => array:3 [ "identificador" => "bib0335" "etiqueta" => "30" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Left ventricular true aneurysm: diagnosis of myocardial viability shown on MR" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "B. Kumbasar" 1 => "K.C. Wu" 2 => "I.R. Kamel" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Am J Roentgenology" "fecha" => "2002" "volumen" => "179" "paginaInicial" => "472" "paginaFinal" => "474" ] ] ] ] ] ] 30 => array:3 [ "identificador" => "bib0340" "etiqueta" => "31" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "False aneurysm of the left ventricle: identification of distinctive clinical, radiographic and angiographic diagnosis" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "C.B. Higgins" 1 => "M.J. Lipton" 2 => "A.D. Johnson" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1148/127.1.21" "Revista" => array:6 [ "tituloSerie" => "Radiology" "fecha" => "1978" "volumen" => "127" "paginaInicial" => "21" "paginaFinal" => "27" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/635185" "web" => "Medline" ] ] ] ] ] ] ] ] 31 => array:3 [ "identificador" => "bib0345" "etiqueta" => "32" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Pseudoaneurysm of the left ventricle: radiographic and angiocardiographic diagnosis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "H. Spindola-Franco" 1 => "N. Kronacher" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1148/127.1.29" "Revista" => array:6 [ "tituloSerie" => "Radiology" "fecha" => "1978" "volumen" => "127" "paginaInicial" => "29" "paginaFinal" => "34" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/635201" "web" => "Medline" ] ] ] ] ] ] ] ] 32 => array:3 [ "identificador" => "bib0350" "etiqueta" => "33" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Ventricular reconstruction for ischemic cardiomyopathy" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "L.L. Mickleborough" 1 => "N. Merchant" 2 => "Y. Provost" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Ann Thorac Surg" "fecha" => "2003" "volumen" => "75" "paginaInicial" => "S6" "paginaFinal" => "S12" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12820729" "web" => "Medline" ] ] ] ] ] ] ] ] 33 => array:3 [ "identificador" => "bib0355" "etiqueta" => "34" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Cardiac magnetic resonance imaging for the assessment of ventricular function, geometry, and viability before and after surgical ventricular reconstruction" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "J. Huther" 1 => "T. Doenst" 2 => "S. Nitzsche" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.jtcvs.2011.04.040" "Revista" => array:6 [ "tituloSerie" => "J Thorac Cardiovasc Surg" "fecha" => "2011" "volumen" => "142" "paginaInicial" => "1515" "paginaFinal" => "1522" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21907357" "web" => "Medline" ] ] ] ] ] ] ] ] 34 => array:3 [ "identificador" => "bib0360" "etiqueta" => "35" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Idiopathic left ventricular aneurysm: a clinical and pathological study of a new entity in the spectrum of cardiomyopathies" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "L. Mestroni" 1 => "T. Morgera" 2 => "D. Miani" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Postgrad Med J" "fecha" => "1994" "volumen" => "70" "paginaInicial" => "S13" "paginaFinal" => "S20" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/7971643" "web" => "Medline" ] ] ] ] ] ] ] ] 35 => array:3 [ "identificador" => "bib0365" "etiqueta" => "36" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "An underrecognized subepicardial reentrant ventricular tachycardia attributable to left ventricular aneurysm in patients with normal coronary arteriograms" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "F. Ouyang" 1 => "M. Antz" 2 => "F.T. Deger" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1161/01.CIR.0000068343.69532.B6" "Revista" => array:6 [ "tituloSerie" => "Circulation" "fecha" => "2003" "volumen" => "107" "paginaInicial" => "2702" "paginaFinal" => "2709" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12743007" "web" => "Medline" ] ] ] ] ] ] ] ] 36 => array:3 [ "identificador" => "bib0370" "etiqueta" => "37" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Arrhythmogenic ventricular aneurysms unrelated to coronary artery disease" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "H.A. Rajasinghe" 1 => "H.P. Lorenz" 2 => "M.T. Longaker" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Ann Thorac Surg" "fecha" => "1995" "volumen" => "59" "paginaInicial" => "1079" "paginaFinal" => "1084" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/7733701" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/08702551/0000003500000002/v1_201602130045/S0870255116000044/v1_201602130045/en/main.assets" "Apartado" => array:4 [ "identificador" => "362" "tipo" => "SECCION" "pt" => array:2 [ "titulo" => "Casos clínicos" "idiomaDefecto" => true ] "idiomaDefecto" => "pt" ] "PDF" => "https://static.elsevier.es/multimedia/08702551/0000003500000002/v1_201602130045/S0870255116000044/v1_201602130045/en/main.pdf?idApp=UINPBA00004E&text.app=https://revportcardiol.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0870255116000044?idApp=UINPBA00004E"]

Estatísticas

Case report

Multiple left ventricular aneurysms in a young female

Múltiplos aneurismas do ventrículo esquerdo numa jovem

Abhishek P. Raval

Autor para correspondência

docabs4u@gmail.com

Corresponding author.

, Anand Shukla, Rajiv Garg, Yashpal Rana, Komal Shah

U.N. Mehta Institute of Cardiology and Research Centre (UNMICRC), Ahmedabad, India

Lido

8455

Vezes
que se leu este artigo

1878

Total PDF

6577

Total HTML

Compartilhar estatísticas

 array:25 [
  "pii" => "S0870255116000044"
  "issn" => "08702551"
  "doi" => "10.1016/j.repc.2015.09.020"
  "estado" => "S300"
  "fechaPublicacion" => "2016-02-01"
  "aid" => "763"
  "copyright" => "Sociedade Portuguesa de Cardiologia"
  "copyrightAnyo" => "2016"
  "documento" => "simple-article"
  "crossmark" => 1
  "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/"
  "subdocumento" => "crp"
  "cita" => "Rev Port Cardiol. 2016;35:113&#46;e1-6"
  "abierto" => array:3 [
    "ES" => true
    "ES2" => true
    "LATM" => true
  ]
  "gratuito" => true
  "lecturas" => array:2 [
    "total" => 4161
    "formatos" => array:3 [
      "EPUB" => 188
      "HTML" => 3429
      "PDF" => 544
    ]
  ]
  "Traduccion" => array:1 [
    "en" => array:20 [
      "pii" => "S2174204916000283"
      "issn" => "21742049"
      "doi" => "10.1016/j.repce.2016.02.001"
      "estado" => "S300"
      "fechaPublicacion" => "2016-02-01"
      "aid" => "763"
      "copyright" => "Sociedade Portuguesa de Cardiologia"
      "documento" => "simple-article"
      "crossmark" => 1
      "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/"
      "subdocumento" => "crp"
      "cita" => "Rev Port Cardiol. 2016;35:113&#46;e1-6"
      "abierto" => array:3 [
        "ES" => true
        "ES2" => true
        "LATM" => true
      ]
      "gratuito" => true
      "lecturas" => array:2 [
        "total" => 3465
        "formatos" => array:3 [
          "EPUB" => 167
          "HTML" => 2821
          "PDF" => 477
        ]
      ]
      "en" => array:13 [
        "idiomaDefecto" => true
        "cabecera" => "<span class="elsevierStyleTextfn">Case report</span>"
        "titulo" => "Multiple left ventricular aneurysms in a young female"
        "tienePdf" => "en"
        "tieneTextoCompleto" => "en"
        "tieneResumen" => array:2 [
          0 => "en"
          1 => "pt"
        ]
        "paginas" => array:1 [
          0 => array:2 [
            "paginaInicial" => "113&#46;e1"
            "paginaFinal" => "113&#46;e6"
          ]
        ]
        "titulosAlternativos" => array:1 [
          "pt" => array:1 [
            "titulo" => "M&#250;ltiplos aneurismas do ventr&#237;culo esquerdo numa jovem"
          ]
        ]
        "contieneResumen" => array:2 [
          "en" => true
          "pt" => true
        ]
        "contieneTextoCompleto" => array:1 [
          "en" => true
        ]
        "contienePdf" => array:1 [
          "en" => true
        ]
        "resumenGrafico" => array:2 [
          "original" => 0
          "multimedia" => array:7 [
            "identificador" => "fig0010"
            "etiqueta" => "Figure 2"
            "tipo" => "MULTIMEDIAFIGURA"
            "mostrarFloat" => true
            "mostrarDisplay" => false
            "figura" => array:1 [
              0 => array:4 [
                "imagen" => "gr2.jpeg"
                "Alto" => 3264
                "Ancho" => 2374
                "Tamanyo" => 675419
              ]
            ]
            "descripcion" => array:1 [
              "en" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Transthoracic two-dimensional echocardiogram with color Doppler&#46; &#40;A&#41; Apical 4-chamber view in systole showing apical aneurysm &#40;&#42;&#41;&#59; &#40;B&#41; parasternal long-axis view in diastole showing submitral aneurysm &#40;&#42;&#42;&#41;&#46;</p>"
            ]
          ]
        ]
        "autores" => array:1 [
          0 => array:2 [
            "autoresLista" => "Abhishek P&#46; Raval, Anand Shukla, Rajiv Garg, Yashpal Rana, Komal Shah"
            "autores" => array:5 [
              0 => array:2 [
                "nombre" => "Abhishek P&#46;"
                "apellidos" => "Raval"
              ]
              1 => array:2 [
                "nombre" => "Anand"
                "apellidos" => "Shukla"
              ]
              2 => array:2 [
                "nombre" => "Rajiv"
                "apellidos" => "Garg"
              ]
              3 => array:2 [
                "nombre" => "Yashpal"
                "apellidos" => "Rana"
              ]
              4 => array:2 [
                "nombre" => "Komal"
                "apellidos" => "Shah"
              ]
            ]
          ]
        ]
      ]
      "idiomaDefecto" => "en"
      "Traduccion" => array:1 [
        "en" => array:9 [
          "pii" => "S0870255116000044"
          "doi" => "10.1016/j.repc.2015.09.020"
          "estado" => "S300"
          "subdocumento" => ""
          "abierto" => array:3 [
            "ES" => true
            "ES2" => true
            "LATM" => true
          ]
          "gratuito" => true
          "lecturas" => array:1 [
            "total" => 0
          ]
          "idiomaDefecto" => "en"
          "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0870255116000044?idApp=UINPBA00004E"
        ]
      ]
      "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2174204916000283?idApp=UINPBA00004E"
      "url" => "/21742049/0000003500000002/v2_201703220311/S2174204916000283/v2_201703220311/en/main.assets"
    ]
  ]
  "itemSiguiente" => array:20 [
    "pii" => "S0870255116000056"
    "issn" => "08702551"
    "doi" => "10.1016/j.repc.2015.06.013"
    "estado" => "S300"
    "fechaPublicacion" => "2016-02-01"
    "aid" => "764"
    "copyright" => "Sociedade Portuguesa de Cardiologia"
    "documento" => "simple-article"
    "crossmark" => 1
    "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/"
    "subdocumento" => "crp"
    "cita" => "Rev Port Cardiol. 2016;35:115&#46;e1-5"
    "abierto" => array:3 [
      "ES" => true
      "ES2" => true
      "LATM" => true
    ]
    "gratuito" => true
    "lecturas" => array:2 [
      "total" => 2867
      "formatos" => array:3 [
        "EPUB" => 198
        "HTML" => 2139
        "PDF" => 530
      ]
    ]
    "en" => array:13 [
      "idiomaDefecto" => true
      "cabecera" => "<span class="elsevierStyleTextfn">Case report</span>"
      "titulo" => "Transcatheter device closure of pseudoaneurysms of the left ventricular wall&#58; An emerging therapeutic option"
      "tienePdf" => "en"
      "tieneTextoCompleto" => "en"
      "tieneResumen" => array:2 [
        0 => "en"
        1 => "pt"
      ]
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "115&#46;e1"
          "paginaFinal" => "115&#46;e5"
        ]
      ]
      "titulosAlternativos" => array:1 [
        "pt" => array:1 [
          "titulo" => "Tratamento percut&#226;neo com dispositivo de oclus&#227;o de pseudoaneurisma do ventr&#237;culo esquerdo &#8211; uma alternativa terap&#234;utica"
        ]
      ]
      "contieneResumen" => array:2 [
        "en" => true
        "pt" => true
      ]
      "contieneTextoCompleto" => array:1 [
        "en" => true
      ]
      "contienePdf" => array:1 [
        "en" => true
      ]
      "resumenGrafico" => array:2 [
        "original" => 0
        "multimedia" => array:7 [
          "identificador" => "fig0020"
          "etiqueta" => "Figure 4"
          "tipo" => "MULTIMEDIAFIGURA"
          "mostrarFloat" => true
          "mostrarDisplay" => false
          "figura" => array:1 [
            0 => array:4 [
              "imagen" => "gr4.jpeg"
              "Alto" => 850
              "Ancho" => 1500
              "Tamanyo" => 217762
            ]
          ]
          "descripcion" => array:1 [
            "en" => "<p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">&#40;A&#41; and &#40;B&#41; Cardiac computed tomography performed after six months showing complete closure of the defect by Amplatzer septal occluder &#40;arrows&#41;&#46; The asterisks indicate partially thrombosed pseudoaneurysm&#46;</p>"
          ]
        ]
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "Tarun Madan, Manish Juneja, Abhishek Raval, Bhavesh Thakkar"
          "autores" => array:4 [
            0 => array:2 [
              "nombre" => "Tarun"
              "apellidos" => "Madan"
            ]
            1 => array:2 [
              "nombre" => "Manish"
              "apellidos" => "Juneja"
            ]
            2 => array:2 [
              "nombre" => "Abhishek"
              "apellidos" => "Raval"
            ]
            3 => array:2 [
              "nombre" => "Bhavesh"
              "apellidos" => "Thakkar"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "en"
    "Traduccion" => array:1 [
      "en" => array:9 [
        "pii" => "S2174204916000295"
        "doi" => "10.1016/j.repce.2015.07.019"
        "estado" => "S300"
        "subdocumento" => ""
        "abierto" => array:3 [
          "ES" => true
          "ES2" => true
          "LATM" => true
        ]
        "gratuito" => true
        "lecturas" => array:1 [
          "total" => 0
        ]
        "idiomaDefecto" => "en"
        "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2174204916000295?idApp=UINPBA00004E"
      ]
    ]
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0870255116000056?idApp=UINPBA00004E"
    "url" => "/08702551/0000003500000002/v1_201602130045/S0870255116000056/v1_201602130045/en/main.assets"
  ]
  "itemAnterior" => array:19 [
    "pii" => "S0870255115003613"
    "issn" => "08702551"
    "doi" => "10.1016/j.repc.2015.09.016"
    "estado" => "S300"
    "fechaPublicacion" => "2016-02-01"
    "aid" => "757"
    "copyright" => "Sociedade Portuguesa de Cardiologia"
    "documento" => "article"
    "crossmark" => 1
    "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/"
    "subdocumento" => "ssu"
    "cita" => "Rev Port Cardiol. 2016;35:105-12"
    "abierto" => array:3 [
      "ES" => true
      "ES2" => true
      "LATM" => true
    ]
    "gratuito" => true
    "lecturas" => array:2 [
      "total" => 5143
      "formatos" => array:3 [
        "EPUB" => 163
        "HTML" => 4275
        "PDF" => 705
      ]
    ]
    "en" => array:13 [
      "idiomaDefecto" => true
      "cabecera" => "<span class="elsevierStyleTextfn">Review article</span>"
      "titulo" => "Coronary optical coherence tomography&#58; A practical overview of current clinical applications"
      "tienePdf" => "en"
      "tieneTextoCompleto" => "en"
      "tieneResumen" => array:2 [
        0 => "en"
        1 => "pt"
      ]
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "105"
          "paginaFinal" => "112"
        ]
      ]
      "titulosAlternativos" => array:1 [
        "pt" => array:1 [
          "titulo" => "Tomografia de coer&#234;ncia &#243;tica coron&#225;ria&#58; uma revis&#227;o pr&#225;tica das aplica&#231;&#245;es cl&#237;nicas atuais"
        ]
      ]
      "contieneResumen" => array:2 [
        "en" => true
        "pt" => true
      ]
      "contieneTextoCompleto" => array:1 [
        "en" => true
      ]
      "contienePdf" => array:1 [
        "en" => true
      ]
      "resumenGrafico" => array:2 [
        "original" => 0
        "multimedia" => array:7 [
          "identificador" => "fig0015"
          "etiqueta" => "Figure 3"
          "tipo" => "MULTIMEDIAFIGURA"
          "mostrarFloat" => true
          "mostrarDisplay" => false
          "figura" => array:1 [
            0 => array:4 [
              "imagen" => "gr3.jpeg"
              "Alto" => 1765
              "Ancho" => 1625
              "Tamanyo" => 320379
            ]
          ]
          "descripcion" => array:1 [
            "en" => "<p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Optical coherence tomography revealing stent malapposition with a large distance between struts and vessel wall&#46;</p>"
          ]
        ]
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "Rui Cruz Ferreira, Tiago Pereira-da-Silva, Lino Patr&#237;cio, Hiram Bezerra, Marco Costa"
          "autores" => array:5 [
            0 => array:2 [
              "nombre" => "Rui"
              "apellidos" => "Cruz Ferreira"
            ]
            1 => array:2 [
              "nombre" => "Tiago"
              "apellidos" => "Pereira-da-Silva"
            ]
            2 => array:2 [
              "nombre" => "Lino"
              "apellidos" => "Patr&#237;cio"
            ]
            3 => array:2 [
              "nombre" => "Hiram"
              "apellidos" => "Bezerra"
            ]
            4 => array:2 [
              "nombre" => "Marco"
              "apellidos" => "Costa"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "en"
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0870255115003613?idApp=UINPBA00004E"
    "url" => "/08702551/0000003500000002/v1_201602130045/S0870255115003613/v1_201602130045/en/main.assets"
  ]
  "en" => array:19 [
    "idiomaDefecto" => true
    "cabecera" => "<span class="elsevierStyleTextfn">Case report</span>"
    "titulo" => "Multiple left ventricular aneurysms in a young female"
    "tieneTextoCompleto" => true
    "paginas" => array:1 [
      0 => array:2 [
        "paginaInicial" => "113&#46;e1"
        "paginaFinal" => "113&#46;e6"
      ]
    ]
    "autores" => array:1 [
      0 => array:4 [
        "autoresLista" => "Abhishek P&#46; Raval, Anand Shukla, Rajiv Garg, Yashpal Rana, Komal Shah"
        "autores" => array:5 [
          0 => array:4 [
            "nombre" => "Abhishek P&#46;"
            "apellidos" => "Raval"
            "email" => array:1 [
              0 => "docabs4u&#64;gmail&#46;com"
            ]
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">&#42;</span>"
                "identificador" => "cor0005"
              ]
            ]
          ]
          1 => array:2 [
            "nombre" => "Anand"
            "apellidos" => "Shukla"
          ]
          2 => array:2 [
            "nombre" => "Rajiv"
            "apellidos" => "Garg"
          ]
          3 => array:2 [
            "nombre" => "Yashpal"
            "apellidos" => "Rana"
          ]
          4 => array:2 [
            "nombre" => "Komal"
            "apellidos" => "Shah"
          ]
        ]
        "afiliaciones" => array:1 [
          0 => array:2 [
            "entidad" => "U&#46;N&#46; Mehta Institute of Cardiology and Research Centre &#40;UNMICRC&#41;&#44; Ahmedabad&#44; India"
            "identificador" => "aff0005"
          ]
        ]
        "correspondencia" => array:1 [
          0 => array:3 [
            "identificador" => "cor0005"
            "etiqueta" => "&#8270;"
            "correspondencia" => "Corresponding author&#46;"
          ]
        ]
      ]
    ]
    "titulosAlternativos" => array:1 [
      "pt" => array:1 [
        "titulo" => "M&#250;ltiplos aneurismas do ventr&#237;culo esquerdo numa jovem"
      ]
    ]
    "resumenGrafico" => array:2 [
      "original" => 0
      "multimedia" => array:7 [
        "identificador" => "fig0020"
        "etiqueta" => "Figure 4"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr4.jpeg"
            "Alto" => 1455
            "Ancho" => 3201
            "Tamanyo" => 286203
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Cardiac magnetic resonance imaging&#46; &#40;A&#41; Bright-blood image showing apical aneurysm &#40;white arrow&#41; and submitral aneurysm &#40;red arrow&#41; in vertical long-axis view&#59; &#40;B&#41; bright-blood image showing apical aneurysm &#40;white arrow&#41; and anterior aneurysm &#40;yellow arrow&#41; in 4-chamber view&#46;</p>"
        ]
      ]
    ]
    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Left ventricular aneurysm &#40;LVA&#41; is usually defined as a segment of the ventricular wall that exhibits paradoxical systolic expansion&#59; the term is generally reserved for a discrete&#44; dyskinetic area of the left ventricular &#40;LV&#41; wall with a broad neck&#46;<a class="elsevierStyleCrossRefs" href="#bib0190"><span class="elsevierStyleSup">1&#44;2</span></a> It most frequently develops after myocardial infarction &#40;MI&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">3</span></a> However&#44; other causes may be infectious&#44; inflammatory&#44; metabolic or autoimmune in nature&#46; Multiple idiopathic LVAs are distinctly unusual and rarely reported&#46; The clinical spectrum ranges from asymptomatic to congestive heart failure &#40;CHF&#41; to life-threatening ventricular arrhythmias and cardiac arrest&#46;<a class="elsevierStyleCrossRefs" href="#bib0200"><span class="elsevierStyleSup">3&#44;4</span></a> Herein&#44; we report the case of a young female with multiple large LVAs&#44; managed conservatively in the absence of overt CHF&#44; arrhythmias and embolism&#44; with excellent outcome&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Case report</span><p id="par0010" class="elsevierStylePara elsevierViewall">A 29-year-old woman presented with easy fatigability and chest discomfort for several months&#46; These symptoms were insidious in onset and progressed little&#46; There was no history of palpitations&#44; syncope or dyspnea&#46; She was hemodynamically stable with diffuse apex beat shifted downward and outward&#46; The chest radiograph showed calcified LV apical and basal aneurysms&#46; The electrocardiogram showed no pathological Q waves and normal precordial R-wave progression &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Figure 1</a>&#41;&#46; Two-dimensional transthoracic echocardiography &#40;iE33 xMATRIX&#44; Philips Healthcare&#44; Andover&#44; MA&#44; USA&#41; showed moderate LV dysfunction&#59; multiple LVAs &#40;large apical aneurysm&#44; moderate sized submitral aneurysm&#44; and basal anterior aneurysm&#41;&#59; normal contractility of the rest of the LV wall&#59; and normal valves&#44; other chambers and great vessels &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Figure 2</a>&#41;&#46; The echocardiogram showed continuity of the myocardium of the aneurysms with the rest of the myocardium&#46; Color flow Doppler showed flow in and out of the aneurysms&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">The coronary angiogram &#40;Philips Medical Systems&#44; Nederland B&#46;V&#46;&#41; showed normal epicardial coronaries&#46; Catheterization showed LV pressure of 114&#47;3 mmHg&#46; Systemic and pulmonary arterial&#44; right atrial and ventricular pressures were also normal&#46; The left ventriculogram showed a large LV apical aneurysm with a heavily calcified thrombosed distal part&#44; a large aneurysm of the basal anterior wall with a smooth and calcified distal part&#44; and a moderate sized submitral aneurysm&#46; All the aneurysms had large necks&#44; poor contractility and paradoxical systolic filling&#46; Contrast clearance was slightly delayed by a beat &#40;<a class="elsevierStyleCrossRef" href="#fig0015">Figure 3</a>&#41;&#46;</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0020" class="elsevierStylePara elsevierViewall">To further evaluate LV function and anatomy and the shape of the aneurysms and to differentiate between true and pseudoaneurysms&#44; magnetic resonance imaging &#40;MRI&#41; &#40;Achieva 1&#46;5 T system&#44; Philips Healthcare&#44; Andover&#44; USA&#41; was performed&#46; Using a dedicated cardiac coil&#44; images were acquired with electrocardiographic gating and balanced turbo field echo&#47;fast field echo in short-axis&#44; vertical long-axis&#44; 4-chamber and transverse planes&#44; followed by perfusion studies and delayed contrast-enhanced imaging&#46; These showed LV ejection fraction of 39&#46;5&#37; and stroke volume of 55&#46;4 ml&#46; Images were analyzed for the location of aneurysms&#44; maximal internal width of the orifice&#44; and maximal parallel internal diameter&#46; The largest outpouching on the anterolateral wall of the LV showed thinning of the overlying myocardium &#40;thickness 3&#46;5 mm&#41;&#46; The neck and maximum diameter were both 24 mm and the ratio of maximal internal width of the orifice and maximal parallel internal diameter was 1&#46;0&#46; There was no delayed pericardial enhancement&#46; All these findings suggested that this was a true aneurysm&#46; Other aneurysms on the anterior wall and submitral area were smaller and had similar characteristics &#40;<a class="elsevierStyleCrossRef" href="#fig0020">Figure 4</a>&#41;&#46; MRI ruled out inflammatory and infiltrative disorders&#46;</p><elsevierMultimedia ident="fig0020"></elsevierMultimedia><p id="par0025" class="elsevierStylePara elsevierViewall">The patient denied a history of rheumatic or systemic diseases&#44; toxin exposure or chest trauma&#46; There was no involvement of skin&#44; mucosa or other organ systems&#46; Family history was insignificant for CHF&#44; cardiomyopathy&#44; arrhythmias or sudden cardiac death&#46; Serum levels of inflammatory markers &#40;erythrocyte sedimentation rate and C-reactive protein&#41;&#44; cardiac biomarkers and serum protein electrophoresis were normal&#46; Investigations for Chagas disease&#44; syphilis&#44; sarcoidosis&#44; tuberculosis&#44; connective tissue diseases&#44; and human immunodeficiency virus &#40;HIV&#41; were negative&#46; Holter monitoring performed to screen for ventricular extrasystoles and tachyarrhythmias was normal&#46; Abdominal ultrasound showed normal liver and kidneys&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">Considering the idiopathic nature of the aneurysms and the absence of overt decompensated CHF&#44; angina&#44; arrhythmias and embolism&#44; the patient was considered for medical management in the form of beta-blockers to prevent arrhythmias and warfarin to prevent systemic embolism&#46; At 18 months of follow-up she was free of CHF&#44; arrhythmias and embolism&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Discussion</span><p id="par0035" class="elsevierStylePara elsevierViewall">LVAs are usually classified as congenital or acquired&#44; i&#46;e&#46; arising from a cardiac or non-cardiac disorder&#46;<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">3</span></a> Acquired LVAs most frequently result from MI<a class="elsevierStyleCrossRefs" href="#bib0200"><span class="elsevierStyleSup">3&#44;5</span></a> or coronary artery malformations such as fistulas&#46;<a class="elsevierStyleCrossRef" href="#bib0215"><span class="elsevierStyleSup">6</span></a> They may also be present in arrhythmogenic right ventricular cardiomyopathy&#44;<a class="elsevierStyleCrossRef" href="#bib0220"><span class="elsevierStyleSup">7</span></a> hypertrophic cardiomyopathy&#44;<a class="elsevierStyleCrossRef" href="#bib0225"><span class="elsevierStyleSup">8</span></a> and myocarditis&#46;<a class="elsevierStyleCrossRef" href="#bib0230"><span class="elsevierStyleSup">9</span></a> Underlying non-cardiac systemic diseases include sarcoidosis&#44;<a class="elsevierStyleCrossRef" href="#bib0235"><span class="elsevierStyleSup">10</span></a> Chagas disease&#44;<a class="elsevierStyleCrossRef" href="#bib0240"><span class="elsevierStyleSup">11</span></a> lupus erythematosus&#44;<a class="elsevierStyleCrossRef" href="#bib0245"><span class="elsevierStyleSup">12</span></a> Behcet&#39;s disease&#44;<a class="elsevierStyleCrossRef" href="#bib0250"><span class="elsevierStyleSup">13</span></a> tuberculosis&#44;<a class="elsevierStyleCrossRef" href="#bib0205"><span class="elsevierStyleSup">4</span></a> syphilis<a class="elsevierStyleCrossRef" href="#bib0255"><span class="elsevierStyleSup">14</span></a> or HIV&#46;<a class="elsevierStyleCrossRef" href="#bib0260"><span class="elsevierStyleSup">15</span></a> As a rare complication&#44; LVAs have also been observed in glycogen storage diseases&#44;<a class="elsevierStyleCrossRef" href="#bib0265"><span class="elsevierStyleSup">16</span></a> hyperimmunoglobulin-E syndrome<a class="elsevierStyleCrossRef" href="#bib0270"><span class="elsevierStyleSup">17</span></a> and blunt chest trauma&#46;<a class="elsevierStyleCrossRef" href="#bib0275"><span class="elsevierStyleSup">18</span></a> Congenital LVAs &#40;occurring in the perinatal period&#41; have been detected as early as the second trimester of gestation<a class="elsevierStyleCrossRef" href="#bib0280"><span class="elsevierStyleSup">19</span></a> and have been associated with severe comorbidities and intrauterine death&#46; Idiopathic LVAs &#40;without an identifiable underlying cause&#41; are rare&#46;<a class="elsevierStyleCrossRefs" href="#bib0200"><span class="elsevierStyleSup">3&#44;20</span></a> Weakness of the LV wall&#44; with herniation of the endocardium under the influence of ventricular pressure&#44; and resulting in the formation of a fibrous walled aneurysm with calcium and thrombus deposits in its walls&#44; sometimes with adhesions to the adjacent pericardium&#44; has been suggested as the underlying pathogenesis&#46;<a class="elsevierStyleCrossRef" href="#bib0290"><span class="elsevierStyleSup">21</span></a> Idiopathic submitral LVA&#44; of non-ischemic origin&#44; a rare entity&#44; is commonly described in young black Africans and sometimes in Caucasians&#46;<a class="elsevierStyleCrossRef" href="#bib0295"><span class="elsevierStyleSup">22</span></a> The higher prevalence in certain ethnic groups and the absence of a clear etiology suggest a congenital etiology&#46;<a class="elsevierStyleCrossRef" href="#bib0295"><span class="elsevierStyleSup">22</span></a> Idiopathic LVA appears to be caused by an abnormality in the junction between the cardiac muscle and the fibrous structure of the heart&#46; It can vary in size from millimeters to several centimeters&#46;<a class="elsevierStyleCrossRef" href="#bib0295"><span class="elsevierStyleSup">22</span></a> These are anatomically distinct from congenital diverticula&#44; which are defined as having only a narrow communication with the ventricle&#46;<a class="elsevierStyleCrossRef" href="#bib0260"><span class="elsevierStyleSup">15</span></a> Multiple idiopathic LVAs are distinctly unusual and are rarely reported&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">As with aneurysms of atherosclerotic origin&#44; these entities may be associated with a variety of symptoms&#44; including chest discomfort&#44;<a class="elsevierStyleCrossRef" href="#bib0285"><span class="elsevierStyleSup">20</span></a> ventricular tachyarrhythmias leading to sudden cardiac death&#44;<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">3</span></a> angina&#44;<a class="elsevierStyleCrossRef" href="#bib0300"><span class="elsevierStyleSup">23</span></a> CHF&#44;<a class="elsevierStyleCrossRef" href="#bib0205"><span class="elsevierStyleSup">4</span></a> or recurrent thromboembolism&#46;<a class="elsevierStyleCrossRef" href="#bib0285"><span class="elsevierStyleSup">20</span></a> The tissue of the LVA has been described as inhomogeneous&#44; with viable&#44; normal myocytes&#44; fibrotic tissue&#44; and&#47;or hypertrophic myocytes&#46;<a class="elsevierStyleCrossRefs" href="#bib0200"><span class="elsevierStyleSup">3&#44;4&#44;24</span></a> This may well represent an arrhythmogenic substrate due to local conduction delay and dispersion of excitability and refractoriness&#44; which may be augmented by catecholamines during exercise or mental stress&#46;<a class="elsevierStyleCrossRef" href="#bib0310"><span class="elsevierStyleSup">25</span></a> A study has demonstrated that inflammatory LV microaneurysms&#44; often of viral origin&#44; can be a cause of idiopathic ventricular tachyarrhythmias&#46;<a class="elsevierStyleCrossRef" href="#bib0315"><span class="elsevierStyleSup">26</span></a> In addition&#44; large aneurysms interfere with LV performance through loss of contractile tissue due to mixture of scar tissue and viable myocardium and also by a paradoxical expansion&#44;<a class="elsevierStyleCrossRef" href="#bib0190"><span class="elsevierStyleSup">1</span></a> leading to CHF&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">LVAs have been depicted and characterized by various imaging modalities&#46;<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">3</span></a> Radionuclide ventriculography and echocardiography can demonstrate LVAs more readily&#46;<a class="elsevierStyleCrossRef" href="#bib0190"><span class="elsevierStyleSup">1</span></a> A definitive diagnosis of LVA is best made non-invasively by echocardiography&#44; which also helps in distinguishing a true from a pseudoaneurysm based on the demonstration of a narrow neck in relation to cavity size in the latter&#46;<a class="elsevierStyleCrossRef" href="#bib0320"><span class="elsevierStyleSup">27</span></a> The myocardium surrounding a true aneurysm is in continuity with the rest of the myocardium&#44; as in our case&#44; while there is no myocardium around a pseudoaneurysm&#44; leading to a breach in the continuity of the normal myocardium&#46;<a class="elsevierStyleCrossRef" href="#bib0325"><span class="elsevierStyleSup">28</span></a> An abrupt discontinuity of the endocardial image between the aneurysm and adjacent normal myocardium is a characteristic finding with a pseudoaneurysm&#46;<a class="elsevierStyleCrossRef" href="#bib0255"><span class="elsevierStyleSup">14</span></a> True and pseudoaneurysms can both be non-contractile or dyskinetic and may contain thrombus&#46;<a class="elsevierStyleCrossRefs" href="#bib0325"><span class="elsevierStyleSup">28&#44;29</span></a> Color flow Doppler is useful in establishing the diagnosis as flow in and out of the aneurysm&#44; as well as abnormal flow within it&#44; can be detected&#46; Pulsed Doppler imaging can reveal a to-and-fro pattern with characteristic respiratory variation in peak systolic velocity&#46;<a class="elsevierStyleCrossRef" href="#bib0190"><span class="elsevierStyleSup">1</span></a> However&#44; echocardiography has the limitation of occasional failure to define the neck&#46;<a class="elsevierStyleCrossRef" href="#bib0335"><span class="elsevierStyleSup">30</span></a></p><p id="par0050" class="elsevierStylePara elsevierViewall">Left ventriculography is another potential tool that can detect an abnormal bulge or dyskinetic wall motion in the LV contour during systole&#59; however&#44; it is an invasive method&#46; True aneurysms have a wider neck&#44; as in our case&#44; in contrast to the narrow neck of a pseudoaneurysm&#46;<a class="elsevierStyleCrossRefs" href="#bib0340"><span class="elsevierStyleSup">31&#44;32</span></a> Contrast remains within the cavity of the pseudoaneurysm for several beats after injection&#46;<a class="elsevierStyleCrossRefs" href="#bib0340"><span class="elsevierStyleSup">31&#44;32</span></a> Coronary arteries can extend on the aneurysmal wall in a true aneurysm&#44; while&#44; in a pseudoaneurysm with disrupted myocardium&#44; a cavity is created by blood and pericardium and the coronaries do not drape over this paraventricular chamber&#46;<a class="elsevierStyleCrossRef" href="#bib0345"><span class="elsevierStyleSup">32</span></a> A true aneurysm is less likely than a pseudoaneurysm to be secondary to MI&#44; leading to abnormal patency of at least one of the coronary arteries&#46; Other clues include a characteristic bulge and calcified LV silhouette on the chest radiograph&#44; which is a specific finding but not sensitive&#46;<a class="elsevierStyleCrossRef" href="#bib0190"><span class="elsevierStyleSup">1</span></a> The presence of a discrete bulge anteriorly is more in favor of a true aneurysm&#46;<a class="elsevierStyleCrossRef" href="#bib0335"><span class="elsevierStyleSup">30</span></a> In the case of a pseudoaneurysm&#44; the chest X-ray may show a pericardial mass with a characteristic notch at the border of the mass&#46;<a class="elsevierStyleCrossRef" href="#bib0255"><span class="elsevierStyleSup">14</span></a> In our case&#44; by contrast&#44; the borders were relatively smooth and a bulge was present anteriorly&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">Recently&#44; MRI has emerged as the preferred non-invasive technique for assessment of LV shape&#44; the degree of aneurysm thinning&#44; and resectability&#46;<a class="elsevierStyleCrossRefs" href="#bib0350"><span class="elsevierStyleSup">33&#44;34</span></a> MRI can distinguish between pericardium&#44; thrombus&#44; and myocardium&#44; which are not easily distinguished by contrast ventriculography&#44;<a class="elsevierStyleCrossRef" href="#bib0335"><span class="elsevierStyleSup">30</span></a> and helps resolve uncertainty between a true and a pseudoaneurysm&#46; Contrast-enhanced MRI provides additional information on myocardial tissue characteristics&#44; perfusion&#44; and viability&#46;<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">3</span></a> In the case of a true aneurysm&#44; the tissue making up the wall of the aneurysm shows delayed myocardial enhancement&#46; As the wall of a pseudoaneurysm is composed only of pericardium&#44; it shows no delayed myocardial enhancement&#59; however&#44; its border does show enhancement&#46;<a class="elsevierStyleCrossRef" href="#bib0335"><span class="elsevierStyleSup">30</span></a> Pseudoaneurysms may show delayed pericardial enhancement&#46;<a class="elsevierStyleCrossRef" href="#bib0330"><span class="elsevierStyleSup">29</span></a> The ratio of maximal internal width of the orifice and maximal parallel internal diameter of 1&#46;0 and the absence of delayed pericardial enhancement confirmed the aneurysms as true ones in the case presented&#46;<a class="elsevierStyleCrossRef" href="#bib0330"><span class="elsevierStyleSup">29</span></a> To elucidate the pathogenesis further&#44; radionuclide imaging techniques can be used to assess myocardial viability &#40;2-&#91;fluorine-18&#93;fluoro-2-deoxy-D-glucose positron emission tomography&#41; and regional sympathetic innervation &#40;&#91;iodine-123&#93;metaiodobenzylguanidine single photon emission computed tomography&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">3</span></a> Endomyocardial biopsy can demonstrate myocarditis&#44; sarcoidosis&#44; arrhythmogenic right ventricular cardiomyopathy&#44; or storage disease&#46;<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">3</span></a> Programmed ventricular stimulation can help to induce clinically silent arrhythmias&#46;<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">3</span></a> As there was no history suggestive of hemodynamically significant arrhythmias&#44; we assessed our patient with Holter monitoring only&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">Treatment and prognosis of idiopathic LVAs are dependent on their size&#44; location&#44; and degree of valvular involvement&#44; CHF functional class&#44; and presence of ventricular tachyarrhythmias&#46;<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">3</span></a> Management strategies therefore range from antiarrhythmic drugs<a class="elsevierStyleCrossRef" href="#bib0360"><span class="elsevierStyleSup">35</span></a> to ablation for ventricular tachycardia&#44;<a class="elsevierStyleCrossRef" href="#bib0365"><span class="elsevierStyleSup">36</span></a> implantation of a cardioverter-defibrillator&#44;<a class="elsevierStyleCrossRef" href="#bib0305"><span class="elsevierStyleSup">24</span></a> treatment of CHF<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">3</span></a> or &#40;less frequently&#41; surgical aneurysmectomy&#46;<a class="elsevierStyleCrossRef" href="#bib0370"><span class="elsevierStyleSup">37</span></a> The latter is carried out to improve clinical manifestations&#44; mostly CHF but sometimes also angina&#44; embolization&#44; and life-threatening tachyarrhythmias&#46;<a class="elsevierStyleCrossRef" href="#bib0190"><span class="elsevierStyleSup">1</span></a> However&#44; prospective long-term follow-up studies comparing the different strategies are not available&#46;<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">3</span></a> Our patient was successfully managed with beta-blockers to prevent arrhythmias and oral anticoagulants to prevent thromboembolism&#46; Idiopathic multiple LVAs in a young female demonstrated on ventriculography were reported to be treated conservatively with medical therapy with acceptable clinical course and without adverse clinical sequelae&#46;<a class="elsevierStyleCrossRef" href="#bib0285"><span class="elsevierStyleSup">20</span></a></p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Conclusion</span><p id="par0065" class="elsevierStylePara elsevierViewall">Multiple LVAs in a patient can be idiopathic in nature and have varied presentations&#46; They can be managed conservatively in the absence of angina&#44; decompensated CHF and tachyarrhythmias&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Ethical disclosures</span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Protection of human and animal subjects</span><p id="par0070" class="elsevierStylePara elsevierViewall">The authors declare that no experiments were performed on humans or animals for this study&#46;</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Confidentiality of data</span><p id="par0075" class="elsevierStylePara elsevierViewall">The authors declare that no patient data appear in this article&#46;</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">Right to privacy and informed consent</span><p id="par0080" class="elsevierStylePara elsevierViewall">The authors have obtained the written informed consent of the patients or subjects mentioned in the article&#46; The corresponding author is in possession of this document&#46;</p></span></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Conflicts of interest</span><p id="par0085" class="elsevierStylePara elsevierViewall">The authors have no conflicts of interest to declare&#46;</p></span></span>"
    "textoCompletoSecciones" => array:1 [
      "secciones" => array:11 [
        0 => array:3 [
          "identificador" => "xres604829"
          "titulo" => "Abstract"
          "secciones" => array:1 [
            0 => array:1 [
              "identificador" => "abst0005"
            ]
          ]
        ]
        1 => array:2 [
          "identificador" => "xpalclavsec618935"
          "titulo" => "Keywords"
        ]
        2 => array:3 [
          "identificador" => "xres604830"
          "titulo" => "Resumo"
          "secciones" => array:1 [
            0 => array:1 [
              "identificador" => "abst0010"
            ]
          ]
        ]
        3 => array:2 [
          "identificador" => "xpalclavsec618934"
          "titulo" => "Palavras-chave"
        ]
        4 => array:2 [
          "identificador" => "sec0005"
          "titulo" => "Introduction"
        ]
        5 => array:2 [
          "identificador" => "sec0010"
          "titulo" => "Case report"
        ]
        6 => array:2 [
          "identificador" => "sec0015"
          "titulo" => "Discussion"
        ]
        7 => array:2 [
          "identificador" => "sec0020"
          "titulo" => "Conclusion"
        ]
        8 => array:3 [
          "identificador" => "sec0025"
          "titulo" => "Ethical disclosures"
          "secciones" => array:3 [
            0 => array:2 [
              "identificador" => "sec0030"
              "titulo" => "Protection of human and animal subjects"
            ]
            1 => array:2 [
              "identificador" => "sec0035"
              "titulo" => "Confidentiality of data"
            ]
            2 => array:2 [
              "identificador" => "sec0040"
              "titulo" => "Right to privacy and informed consent"
            ]
          ]
        ]
        9 => array:2 [
          "identificador" => "sec0045"
          "titulo" => "Conflicts of interest"
        ]
        10 => array:1 [
          "titulo" => "References"
        ]
      ]
    ]
    "pdfFichero" => "main.pdf"
    "tienePdf" => true
    "fechaRecibido" => "2014-11-18"
    "fechaAceptado" => "2015-09-02"
    "PalabrasClave" => array:2 [
      "en" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Keywords"
          "identificador" => "xpalclavsec618935"
          "palabras" => array:6 [
            0 => "Chest radiograph"
            1 => "Coronary angiogram"
            2 => "Cardiac catheterization"
            3 => "Ventriculogram"
            4 => "Cardiac magnetic resonance imaging"
            5 => "Aneurysm"
          ]
        ]
      ]
      "pt" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Palavras-chave"
          "identificador" => "xpalclavsec618934"
          "palabras" => array:6 [
            0 => "Radiografia de t&#243;rax"
            1 => "Angiografia coron&#225;ria"
            2 => "Cateterismo card&#237;aco"
            3 => "Ecografia ventricular"
            4 => "Resson&#226;ncia magn&#233;tica card&#237;aca"
            5 => "Aneurisma"
          ]
        ]
      ]
    ]
    "tieneResumen" => true
    "resumen" => array:2 [
      "en" => array:2 [
        "titulo" => "Abstract"
        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Multiple left ventricular aneurysms &#40;LVAs&#41; are rare&#44; especially in a young female&#46; A 29-year-old woman presented vague symptoms&#46; Multiple LVAs were revealed and confirmed on different imaging modalities&#44; including chest radiography&#44; echocardiography&#44; contrast ventriculography and cardiac magnetic resonance imaging&#46; Detailed work-up for probable etiologies including ischemic&#44; infectious&#44; inflammatory and autoimmune causes was negative&#46; In the absence of angina&#44; decompensated congestive heart failure&#44; arrhythmias and embolism&#44; the patient was managed conservatively&#44; with excellent mid-term outcome&#46;</p></span>"
      ]
      "pt" => array:2 [
        "titulo" => "Resumo"
        "resumen" => "<span id="abst0010" class="elsevierStyleSection elsevierViewall"><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">M&#250;ltiplos aneurismas no ventr&#237;culo esquerdo &#40;MAVE&#41; s&#227;o uma situa&#231;&#227;o rara em especial numa jovem que apresentou queixas vagas&#46; V&#225;rios MAVE foram revelados e confirmados em diferentes modalidades de imagem&#46; A doente submeteu-se a radiografia de t&#243;rax&#44; ecocardiografia&#44; ecografia de contraste e resson&#226;ncia magn&#233;tica card&#237;aca&#46; A investiga&#231;&#227;o minuciosa de etiologias isqu&#233;mica&#44; infecciosa&#44; inflamat&#243;ria e autoimune foi negativa&#46; Dada a aus&#234;ncia de angina&#44; insufici&#234;ncia card&#237;aca congestiva&#44; arritmias e embolia&#44; a doente foi tratada de forma conservadora apresentando um excelente progn&#243;stico a m&#233;dio prazo&#46;</p></span>"
      ]
    ]
    "multimedia" => array:4 [
      0 => array:7 [
        "identificador" => "fig0005"
        "etiqueta" => "Figure 1"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr1.jpeg"
            "Alto" => 1433
            "Ancho" => 3285
            "Tamanyo" => 817954
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">&#40;A&#41; Chest radiograph in posteroanterior view showing large calcified left ventricular apical aneurysm &#40;&#42;&#41; and basal aneurysm &#40;&#42;&#42;&#41;&#59; &#40;B&#41; electrocardiogram showing no pathological Q waves and normal progression of precordial R wave&#46;</p>"
        ]
      ]
      1 => array:7 [
        "identificador" => "fig0010"
        "etiqueta" => "Figure 2"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr2.jpeg"
            "Alto" => 1958
            "Ancho" => 1424
            "Tamanyo" => 322165
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Transthoracic two-dimensional echocardiogram with color Doppler&#46; &#40;A&#41; Apical 4-chamber view in systole showing apical aneurysm &#40;&#42;&#41;&#59; &#40;B&#41; parasternal long-axis view in diastole showing submitral aneurysm &#40;&#42;&#42;&#41;&#46;</p>"
        ]
      ]
      2 => array:7 [
        "identificador" => "fig0015"
        "etiqueta" => "Figure 3"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr3.jpeg"
            "Alto" => 1503
            "Ancho" => 2891
            "Tamanyo" => 294638
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Left ventriculogram&#46; &#40;A&#41; Right anterior oblique view in diastole showing apical aneurysm &#40;&#42;&#41;&#44; basal anterior aneurysm &#40;&#42;&#42;&#41;&#44; submitral aneurysm &#40;&#42;&#42;&#42;&#41; and normal left coronary artery branches &#40;arrow&#41;&#59; &#40;B&#41; lateral view in diastole showing LV apical aneurysm &#40;&#42;&#41;&#44; basal anterior aneurysm &#40;&#42;&#42;&#41; and normal left coronary artery branches &#40;arrow&#41;&#46;</p>"
        ]
      ]
      3 => array:7 [
        "identificador" => "fig0020"
        "etiqueta" => "Figure 4"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr4.jpeg"
            "Alto" => 1455
            "Ancho" => 3201
            "Tamanyo" => 286203
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Cardiac magnetic resonance imaging&#46; &#40;A&#41; Bright-blood image showing apical aneurysm &#40;white arrow&#41; and submitral aneurysm &#40;red arrow&#41; in vertical long-axis view&#59; &#40;B&#41; bright-blood image showing apical aneurysm &#40;white arrow&#41; and anterior aneurysm &#40;yellow arrow&#41; in 4-chamber view&#46;</p>"
        ]
      ]
    ]
    "bibliografia" => array:2 [
      "titulo" => "References"
      "seccion" => array:1 [
        0 => array:2 [
          "identificador" => "bibs0005"
          "bibliografiaReferencia" => array:37 [
            0 => array:3 [
              "identificador" => "bib0190"
              "etiqueta" => "1"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Stable ischemic heart disease"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "D&#46;A&#46; Morrow"
                            1 => "W&#46;E&#46; Boden"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "LibroEditado" => array:5 [
                        "titulo" => "Braunwald&#39;s heart disease&#58; a textbook of cardiovascular medicine"
                        "paginaInicial" => "1182"
                        "paginaFinal" => "1244"
                        "edicion" => "10th ed&#46;"
                        "serieFecha" => "2014"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            1 => array:3 [
              "identificador" => "bib0195"
              "etiqueta" => "2"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "ST-elevation myocardial infarction&#58; management"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "J&#46;L&#46; Mega"
                            1 => "D&#46;A&#46; Morrow"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "LibroEditado" => array:5 [
                        "titulo" => "Braunwald&#39;s heart disease&#58; a textbook of cardiovascular medicine"
                        "paginaInicial" => "1095"
                        "paginaFinal" => "1154"
                        "edicion" => "10th ed&#46;"
                        "serieFecha" => "2014"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            2 => array:3 [
              "identificador" => "bib0200"
              "etiqueta" => "3"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Idiopathic left ventricular aneurysm and sudden cardiac death in young adults"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "M&#46; Paul"
                            1 => "M&#46; Sch&#228;fers"
                            2 => "M&#46; Grude"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1093/europace/eul074"
                      "Revista" => array:6 [
                        "tituloSerie" => "Europace"
                        "fecha" => "2006"
                        "volumen" => "8"
                        "paginaInicial" => "607"
                        "paginaFinal" => "612"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16864613"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            3 => array:3 [
              "identificador" => "bib0205"
              "etiqueta" => "4"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Congenital left ventricular aneurysm&#58; clinical&#44; imaging&#44; pathologic&#44; and surgical findings in seven new cases"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "J&#46; Papagiannis"
                            1 => "R&#46; Van Praagh"
                            2 => "O&#46; Schwint"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1067/mhj.2001.113076"
                      "Revista" => array:6 [
                        "tituloSerie" => "Am Heart J"
                        "fecha" => "2001"
                        "volumen" => "141"
                        "paginaInicial" => "491"
                        "paginaFinal" => "499"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11231449"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            4 => array:3 [
              "identificador" => "bib0210"
              "etiqueta" => "5"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Left ventricular aneurysm formation after anterior myocardial infarction&#58; clinical and angiographic determinants in 809 patients"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "H&#46; Tikiz"
                            1 => "R&#46; Atak"
                            2 => "Y&#46; Balbay"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Int J Cardiol"
                        "fecha" => "2002"
                        "volumen" => "82"
                        "paginaInicial" => "7"
                        "paginaFinal" => "14"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11786151"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            5 => array:3 [
              "identificador" => "bib0215"
              "etiqueta" => "6"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Right coronary artery to left ventricular fistula associated with left ventricular aneurysm"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "N&#46; Atsumi"
                            1 => "H&#46; Horigome"
                            2 => "W&#46; Mihara"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1007/s002469910031"
                      "Revista" => array:6 [
                        "tituloSerie" => "Pediatr Cardiol"
                        "fecha" => "2000"
                        "volumen" => "21"
                        "paginaInicial" => "172"
                        "paginaFinal" => "174"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10754093"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            6 => array:3 [
              "identificador" => "bib0220"
              "etiqueta" => "7"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Evolution of left ventricular involvement in arrhythmogenic right ventricular cardiomyopathy"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "M&#46; Horimoto"
                            1 => "M&#46; Akino"
                            2 => "T&#46; Takenaka"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "7026"
                      "Revista" => array:6 [
                        "tituloSerie" => "Cardiology"
                        "fecha" => "2000"
                        "volumen" => "93"
                        "paginaInicial" => "197"
                        "paginaFinal" => "200"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10965092"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            7 => array:3 [
              "identificador" => "bib0225"
              "etiqueta" => "8"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Hypertrophic cardiomyopathy with apical left ventricular aneurysm"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "Y&#46; Akutsu"
                            1 => "A&#46; Shinozuka"
                            2 => "T&#46;Y&#46; Huang"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Jpn Circ J"
                        "fecha" => "1998"
                        "volumen" => "62"
                        "paginaInicial" => "127"
                        "paginaFinal" => "131"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/9559432"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            8 => array:3 [
              "identificador" => "bib0230"
              "etiqueta" => "9"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Prognostic significance of left ventricular aneurysm with normal global function caused by myocarditis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "A&#46; Frustaci"
                            1 => "C&#46; Chimenti"
                            2 => "M&#46; Pieroni"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Chest"
                        "fecha" => "2000"
                        "volumen" => "118"
                        "paginaInicial" => "1696"
                        "paginaFinal" => "1702"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11115461"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            9 => array:3 [
              "identificador" => "bib0235"
              "etiqueta" => "10"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Left ventricular apical aneurysm in cardiac sarcoidosis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "H&#46; Kosuge"
                            1 => "M&#46; Noda"
                            2 => "T&#46; Kakuta"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Jpn Heart J"
                        "fecha" => "2001"
                        "volumen" => "42"
                        "paginaInicial" => "265"
                        "paginaFinal" => "269"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11384087"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            10 => array:3 [
              "identificador" => "bib0240"
              "etiqueta" => "11"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Chronic Chagas&#8217; heart disease in a Japanese-Brazilian traveller&#46; A case report"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "M&#46; Takeno"
                            1 => "S&#46; Seto"
                            2 => "F&#46; Kawahara"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Jpn Heart J"
                        "fecha" => "1999"
                        "volumen" => "40"
                        "paginaInicial" => "375"
                        "paginaFinal" => "382"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10506860"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            11 => array:3 [
              "identificador" => "bib0245"
              "etiqueta" => "12"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Acute myocarditis and left ventricular aneurysm as presentations of systemic lupus erythematosus"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "A&#46; Frustaci"
                            1 => "N&#46; Gentiloni"
                            2 => "M&#46; Caldarulo"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Chest"
                        "fecha" => "1996"
                        "volumen" => "109"
                        "paginaInicial" => "282"
                        "paginaFinal" => "284"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/8549201"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            12 => array:3 [
              "identificador" => "bib0250"
              "etiqueta" => "13"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Behcet&#39;s syndrome with left ventricular aneurysm and ruptured renal artery pseudoaneurysm"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "K&#46; Han"
                            1 => "R&#46; Siegel"
                            2 => "A&#46;J&#46; Pantuck"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Urology"
                        "fecha" => "1999"
                        "volumen" => "54"
                        "paginaInicial" => "162"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10754656"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            13 => array:3 [
              "identificador" => "bib0255"
              "etiqueta" => "14"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Left ventricular aneurysm&#58; a review"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "H&#46;A&#46; Ba&#8217;albaki"
                            1 => "S&#46;D&#46; Clements Jr&#46;"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Clin Cardiol"
                        "fecha" => "1989"
                        "volumen" => "12"
                        "paginaInicial" => "5"
                        "paginaFinal" => "13"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/2643491"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            14 => array:3 [
              "identificador" => "bib0260"
              "etiqueta" => "15"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Left ventricular aneurysm in human immunodeficiency virus infection&#58; a case report"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "A&#46; Kane"
                            1 => "L&#46; Hane"
                            2 => "J&#46;M&#46; Dangou"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Arch Mal Coeur Vaiss"
                        "fecha" => "1998"
                        "volumen" => "91"
                        "paginaInicial" => "419"
                        "paginaFinal" => "423"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/9749229"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            15 => array:3 [
              "identificador" => "bib0265"
              "etiqueta" => "16"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Glycogen storage disease associated with left ventricular aneurysm in an elderly patient"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "G&#46; Toda"
                            1 => "T&#46; Yoshimuta"
                            2 => "H&#46; Kawano"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Jpn Circ J"
                        "fecha" => "2001"
                        "volumen" => "65"
                        "paginaInicial" => "462"
                        "paginaFinal" => "464"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11348054"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            16 => array:3 [
              "identificador" => "bib0270"
              "etiqueta" => "17"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Ventricular aneurysm and myocarditis in a child with hyperimmunoglobulin E syndrome"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "I&#46;B&#46; El Noor"
                            1 => "P&#46; Venugopalan"
                            2 => "W&#46;J&#46; Johnston"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Eur Heart J"
                        "fecha" => "1995"
                        "volumen" => "16"
                        "paginaInicial" => "714"
                        "paginaFinal" => "715"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/7588908"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            17 => array:3 [
              "identificador" => "bib0275"
              "etiqueta" => "18"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Coronary milking-like effect caused by systolic expansion of a traumatic focal left ventricular aneurysm"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "V&#46; Marti"
                            1 => "J&#46; Garcia"
                            2 => "J&#46; MaAuge"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Heart"
                        "fecha" => "2001"
                        "volumen" => "85"
                        "paginaInicial" => "622"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11359738"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            18 => array:3 [
              "identificador" => "bib0280"
              "etiqueta" => "19"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Prenatal diagnosis of left ventricular aneurysm in the late second trimester&#58; a case report"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "S&#46;J&#46; Sherman"
                            1 => "K&#46;H&#46; Leenhouts"
                            2 => "G&#46;O&#46; Utter"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1046/j.1469-0705.1996.07060456.x"
                      "Revista" => array:6 [
                        "tituloSerie" => "Ultrasound Obstet Gynecol"
                        "fecha" => "1996"
                        "volumen" => "7"
                        "paginaInicial" => "456"
                        "paginaFinal" => "457"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/8807767"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            19 => array:3 [
              "identificador" => "bib0285"
              "etiqueta" => "20"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Multiple idiopathic left ventricular aneurysms in a Japanese woman"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "G&#46;A&#46; Harris Jr&#46;"
                            1 => "A&#46;K&#46; Wong"
                            2 => "D&#46;A&#46; Lantz"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Mil Med"
                        "fecha" => "1999"
                        "volumen" => "164"
                        "paginaInicial" => "448"
                        "paginaFinal" => "450"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10377718"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            20 => array:3 [
              "identificador" => "bib0290"
              "etiqueta" => "21"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Annular subvalvular left ventricular aneurysms in the South African Bantu"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "E&#46; Chesler"
                            1 => "N&#46; Joffe"
                            2 => "L&#46; Schamroth"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Circulation"
                        "fecha" => "1965"
                        "volumen" => "32"
                        "paginaInicial" => "43"
                        "paginaFinal" => "51"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/14314490"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            21 => array:3 [
              "identificador" => "bib0295"
              "etiqueta" => "22"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Idiopathic left ventricle aneurysm"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "G&#46;R&#46; Molina"
                            1 => "S&#46;A&#46; Zakzuk"
                            2 => "M&#46; Vieira"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Arq Bras Cardiol&#58; imagem cardiovasc"
                        "fecha" => "2014"
                        "volumen" => "27"
                        "paginaInicial" => "105"
                        "paginaFinal" => "108"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            22 => array:3 [
              "identificador" => "bib0300"
              "etiqueta" => "23"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Idiopathic subvalvular aneurysm of the left ventricle&#46; Anatomical&#44; clinical and developmental characteristics&#46; Apropos of 13 cases"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "C&#46; Bouramoue"
                            1 => "J&#46;L&#46; Nkoua"
                            2 => "T&#46; Gombet"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Ann Cardiol Angeiol &#40;Paris&#41;"
                        "fecha" => "1995"
                        "volumen" => "44"
                        "paginaInicial" => "7"
                        "paginaFinal" => "13"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            23 => array:3 [
              "identificador" => "bib0305"
              "etiqueta" => "24"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Idiopathic aneurysm of the left ventricle&#46; Apropos of 4 cases operated on with success"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "A&#46; Rimailho"
                            1 => "C&#46; Cabrol"
                            2 => "R&#46; Soyer"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Arch Mal Coeur Vaiss"
                        "fecha" => "1981"
                        "volumen" => "74"
                        "paginaInicial" => "443"
                        "paginaFinal" => "451"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/6786242"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            24 => array:3 [
              "identificador" => "bib0310"
              "etiqueta" => "25"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Modulation of drug effects by regional sympathetic denervation and supersensitivity"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "M&#46;S&#46; Stanton"
                            1 => "D&#46;P&#46; Zipes"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Circulation"
                        "fecha" => "1991"
                        "volumen" => "84"
                        "paginaInicial" => "1709"
                        "paginaFinal" => "1714"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/1914110"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            25 => array:3 [
              "identificador" => "bib0315"
              "etiqueta" => "26"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Inflammatory left ventricular microaneurysms as a cause of apparently idiopathic ventricular tachyarrhythmias"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "C&#46; Chimenti"
                            1 => "F&#46; Calabrese"
                            2 => "G&#46; Thiene"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Circulation"
                        "fecha" => "2001"
                        "volumen" => "104"
                        "paginaInicial" => "168"
                        "paginaFinal" => "173"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11447081"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            26 => array:3 [
              "identificador" => "bib0320"
              "etiqueta" => "27"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Tomographic three-dimensional echocardiographic determination of chamber size and systolic function in patients with left ventricular aneurysm&#58; comparison to magnetic resonance imaging&#44; cineventriculography&#44; and two-dimensional echocardiography"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "T&#46; Buck"
                            1 => "P&#46; Hunold"
                            2 => "K&#46;U&#46; Wentz"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Circulation"
                        "fecha" => "1997"
                        "volumen" => "96"
                        "paginaInicial" => "4286"
                        "paginaFinal" => "4297"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/9416895"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            27 => array:3 [
              "identificador" => "bib0325"
              "etiqueta" => "28"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Diagnosing left ventricular aneurysm from pseudo-aneurysm&#58; a case report and a review in literature"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "G&#46; Zoffoli"
                            1 => "D&#46; Mangino"
                            2 => "A&#46; Venturini"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1186/1749-8090-4-11"
                      "Revista" => array:5 [
                        "tituloSerie" => "J Cardiothorac Surg"
                        "fecha" => "2009"
                        "volumen" => "4"
                        "paginaInicial" => "11"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19239694"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            28 => array:3 [
              "identificador" => "bib0330"
              "etiqueta" => "29"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "True versus false left ventricular aneurysm&#58; differentiation with MR imaging &#8211; initial experience"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "E&#46; Konen"
                            1 => "N&#46; Merchant"
                            2 => "C&#46; Gutierrez"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1148/radiol.2361031699"
                      "Revista" => array:6 [
                        "tituloSerie" => "Radiology"
                        "fecha" => "2005"
                        "volumen" => "236"
                        "paginaInicial" => "65"
                        "paginaFinal" => "70"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15955851"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            29 => array:3 [
              "identificador" => "bib0335"
              "etiqueta" => "30"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Left ventricular true aneurysm&#58; diagnosis of myocardial viability shown on MR"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "B&#46; Kumbasar"
                            1 => "K&#46;C&#46; Wu"
                            2 => "I&#46;R&#46; Kamel"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Am J Roentgenology"
                        "fecha" => "2002"
                        "volumen" => "179"
                        "paginaInicial" => "472"
                        "paginaFinal" => "474"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            30 => array:3 [
              "identificador" => "bib0340"
              "etiqueta" => "31"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "False aneurysm of the left ventricle&#58; identification of distinctive clinical&#44; radiographic and angiographic diagnosis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "C&#46;B&#46; Higgins"
                            1 => "M&#46;J&#46; Lipton"
                            2 => "A&#46;D&#46; Johnson"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1148/127.1.21"
                      "Revista" => array:6 [
                        "tituloSerie" => "Radiology"
                        "fecha" => "1978"
                        "volumen" => "127"
                        "paginaInicial" => "21"
                        "paginaFinal" => "27"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/635185"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            31 => array:3 [
              "identificador" => "bib0345"
              "etiqueta" => "32"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Pseudoaneurysm of the left ventricle&#58; radiographic and angiocardiographic diagnosis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "H&#46; Spindola-Franco"
                            1 => "N&#46; Kronacher"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1148/127.1.29"
                      "Revista" => array:6 [
                        "tituloSerie" => "Radiology"
                        "fecha" => "1978"
                        "volumen" => "127"
                        "paginaInicial" => "29"
                        "paginaFinal" => "34"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/635201"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            32 => array:3 [
              "identificador" => "bib0350"
              "etiqueta" => "33"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Ventricular reconstruction for ischemic cardiomyopathy"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "L&#46;L&#46; Mickleborough"
                            1 => "N&#46; Merchant"
                            2 => "Y&#46; Provost"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Ann Thorac Surg"
                        "fecha" => "2003"
                        "volumen" => "75"
                        "paginaInicial" => "S6"
                        "paginaFinal" => "S12"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12820729"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            33 => array:3 [
              "identificador" => "bib0355"
              "etiqueta" => "34"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Cardiac magnetic resonance imaging for the assessment of ventricular function&#44; geometry&#44; and viability before and after surgical ventricular reconstruction"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "J&#46; Huther"
                            1 => "T&#46; Doenst"
                            2 => "S&#46; Nitzsche"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.jtcvs.2011.04.040"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Thorac Cardiovasc Surg"
                        "fecha" => "2011"
                        "volumen" => "142"
                        "paginaInicial" => "1515"
                        "paginaFinal" => "1522"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21907357"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            34 => array:3 [
              "identificador" => "bib0360"
              "etiqueta" => "35"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Idiopathic left ventricular aneurysm&#58; a clinical and pathological study of a new entity in the spectrum of cardiomyopathies"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "L&#46; Mestroni"
                            1 => "T&#46; Morgera"
                            2 => "D&#46; Miani"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Postgrad Med J"
                        "fecha" => "1994"
                        "volumen" => "70"
                        "paginaInicial" => "S13"
                        "paginaFinal" => "S20"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/7971643"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            35 => array:3 [
              "identificador" => "bib0365"
              "etiqueta" => "36"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "An underrecognized subepicardial reentrant ventricular tachycardia attributable to left ventricular aneurysm in patients with normal coronary arteriograms"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "F&#46; Ouyang"
                            1 => "M&#46; Antz"
                            2 => "F&#46;T&#46; Deger"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1161/01.CIR.0000068343.69532.B6"
                      "Revista" => array:6 [
                        "tituloSerie" => "Circulation"
                        "fecha" => "2003"
                        "volumen" => "107"
                        "paginaInicial" => "2702"
                        "paginaFinal" => "2709"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12743007"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            36 => array:3 [
              "identificador" => "bib0370"
              "etiqueta" => "37"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Arrhythmogenic ventricular aneurysms unrelated to coronary artery disease"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "H&#46;A&#46; Rajasinghe"
                            1 => "H&#46;P&#46; Lorenz"
                            2 => "M&#46;T&#46; Longaker"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Ann Thorac Surg"
                        "fecha" => "1995"
                        "volumen" => "59"
                        "paginaInicial" => "1079"
                        "paginaFinal" => "1084"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/7733701"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
          ]
        ]
      ]
    ]
  ]
  "idiomaDefecto" => "en"
  "url" => "/08702551/0000003500000002/v1_201602130045/S0870255116000044/v1_201602130045/en/main.assets"
  "Apartado" => array:4 [
    "identificador" => "362"
    "tipo" => "SECCION"
    "pt" => array:2 [
      "titulo" => "Casos cl&#237;nicos"
      "idiomaDefecto" => true
    ]
    "idiomaDefecto" => "pt"
  ]
  "PDF" => "https://static.elsevier.es/multimedia/08702551/0000003500000002/v1_201602130045/S0870255116000044/v1_201602130045/en/main.pdf?idApp=UINPBA00004E&text.app=https://revportcardiol.org/"
  "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0870255116000044?idApp=UINPBA00004E"
]

Informação do artigo

ISSN: 08702551
Idioma original: Inglês

DOI:10.1016/j.repc.2015.09.020

Dados atualizados diariamente

Ano/Mês	Html	Pdf	Total

2024 Novembro	6	4	10
2024 Outubro	38	34	72
2024 Setembro	55	27	82
2024 Agosto	66	24	90
2024 Julho	59	39	98
2024 Junho	37	31	68
2024 Maio	55	23	78
2024 Abril	50	25	75
2024 Mar�o	44	25	69
2024 Fevereiro	48	33	81
2024 Janeiro	37	32	69
2023 Dezembro	45	15	60
2023 Novembro	52	22	74
2023 Outubro	31	17	48
2023 Setembro	31	22	53
2023 Agosto	36	25	61
2023 Julho	31	11	42
2023 Junho	45	12	57
2023 Maio	50	18	68
2023 Abril	35	12	47
2023 Mar�o	45	28	73
2023 Fevereiro	62	24	86
2023 Janeiro	46	8	54
2022 Dezembro	42	17	59
2022 Novembro	63	28	91
2022 Outubro	41	15	56
2022 Setembro	43	29	72
2022 Agosto	56	26	82
2022 Julho	57	39	96
2022 Junho	47	23	70
2022 Maio	43	26	69
2022 Abril	77	32	109
2022 Mar�o	50	41	91
2022 Fevereiro	70	21	91
2022 Janeiro	100	26	126
2021 Dezembro	42	32	74
2021 Novembro	70	40	110
2021 Outubro	83	42	125
2021 Setembro	82	51	133
2021 Agosto	73	28	101
2021 Julho	55	29	84
2021 Junho	47	30	77
2021 Maio	60	23	83
2021 Abril	104	31	135
2021 Mar�o	104	31	135
2021 Fevereiro	98	13	111
2021 Janeiro	56	14	70
2020 Dezembro	66	13	79
2020 Novembro	48	21	69
2020 Outubro	36	17	53
2020 Setembro	56	10	66
2020 Agosto	37	12	49
2020 Julho	76	15	91
2020 Junho	51	8	59
2020 Maio	51	3	54
2020 Abril	69	19	88
2020 Mar�o	63	9	72
2020 Fevereiro	146	21	167
2020 Janeiro	46	6	52
2019 Dezembro	63	8	71
2019 Novembro	53	8	61
2019 Outubro	68	11	79
2019 Setembro	63	16	79
2019 Agosto	42	15	57
2019 Julho	48	13	61
2019 Junho	36	7	43
2019 Maio	55	11	66
2019 Abril	35	16	51
2019 Mar�o	52	22	74
2019 Fevereiro	63	11	74
2019 Janeiro	59	3	62
2018 Dezembro	86	10	96
2018 Novembro	174	12	186
2018 Outubro	484	13	497
2018 Setembro	103	16	119
2018 Agosto	44	16	60
2018 Julho	48	7	55
2018 Junho	71	5	76
2018 Maio	121	11	132
2018 Abril	159	3	162
2018 Mar�o	151	11	162
2018 Fevereiro	103	1	104
2018 Janeiro	17	11	28
2017 Dezembro	186	12	198
2017 Novembro	39	10	49
2017 Outubro	25	7	32
2017 Setembro	40	9	49
2017 Agosto	34	13	47
2017 Julho	31	13	44
2017 Junho	39	10	49
2017 Maio	54	12	66
2017 Abril	35	5	40
2017 Mar�o	49	6	55
2017 Fevereiro	46	7	53
2017 Janeiro	41	5	46
2016 Dezembro	46	10	56
2016 Novembro	31	6	37
2016 Outubro	44	10	54
2016 Setembro	114	5	119
2016 Agosto	31	6	37
2016 Julho	12	5	17
2016 Junho	8	0	8
2016 Maio	2	16	18
2016 Abril	24	2	26
2016 Mar�o	42	35	77
2016 Fevereiro	94	65	159

Mostrar tudo

Indexada em:

Siga-nos:

Estatísticas

Indexada em:

Siga-nos:

Estatísticas

Receba a nossa Newsletter