Rare Form of Saccular Cardiac Aneurysm with Spontaneous Rupture.

A not uncommon late complication of coronary arterial disease and cardiac infarction is ventricular aneurysm, which rarely ruptures except in the presence of reinfarction of the old scar or adjacent myocardium. Commonly such aneurysms develop only at the site of large and healed infarcts, are of considerable size and have a wide communication with the cavity of the chamber involved. Actually many of them represent merely a dilatation of the heart wall rather than aneurysm in the more restricted sense of the term. Among a series of 40 cases of spontaneous rupture of the heart reported by us in a previous paper ' there was encountered one example of rhexis of a true saccular aneurysm communicating with the left ventricular cavity by only a small opening, so that the aneurysm lay over the external surface of the heart. In view of the unique character of the lesion, our failure to encounter an identical example among the exhaustive literature dealing with cardiac rupture, and because the length of the first communication necessitated only a brief consideration of individual instances, we have felt it advisable to make a more detailed account of this particular case A similar aneurysm which, however, failed to rupture was described by Corvisart2 in 1797. It occurred in a negro 27 years of age who entered the hospital "'in inexpressible angiish and anxiety; breathing was laborious and interrupted; he suffered little pain in the thorax, which besides, sounded well in its whole extent; he complained of feeling a violent pain both toward the region of the stomach and of the liver." Death occurred the following day. The heart was reported to be of natural size, " but the superior and lateral portion of the left ventride was surmounted by a tumor almost as large as the heart itself." This tumor was of cartilaginous consistence but of the appearance of muscle, communicated with the ventricle by a small opening, and contained coagula. * Received for publication May 22, 1933.