Left Ventricular Pseudoaneurysm Following Inferior Myocardial Infarction: A Case for Conservative Management

Left ventricular free-wall rupture, a potentially lethal mechanical complication of acute myocardial infarction: an unusual and illustrative case report

BACKGROUND

There are three major mechanical complications after acute myocardial infarction: left ventricular free-wall rupture, ventricular septum rupture and acute mitral valve regurgitation. The left ventricular free-wall rupture is a serious and often lethal complication following an ST elevation myocardial infarction. However, very rarely this rupture can be contained by the pericardium, forming a pseudoaneurysm.

CASE PRESENTATION

We report a case of a 66-year-old man with multiple cardiovascular risk factors and previous ST elevation myocardial infarction, complaining of atypical chest pain. His electrocardiogram was in normal sinus rhythm, with the presence of Q wave in inferior leads and T-wave inversion in lateral leads. A transthoracic echocardiogram showed a left ventricular pseudoaneurysm. In the coronary angiography, multi-vessel disease was found. On-pump CABG was performed and a posterolateral left ventricular giant pseudoaneurysm were observed. Due its "petrous" consistency it was impossible to perform an aneurysmectomy.

CONCLUSIONS

The diagnosis of left ventricular pseudoaneurysm can be difficult, as patients often present either asymptomatic or with non-specific symptoms attributed to other causes. A multimodality imaging diagnostic approach can be necessary. Immediate surgery is considered the treatment of choice because untreated pseudoaneurysms have a high risk of rupture leading to cardiac tamponade, shock and death.

Multimodality Imaging in a Case of Chronic Massive Left Ventricular Pseudoaneurysm

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LV pseudoaneurysm is a rare but fatal complication of myocardial infarction.

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Multimodality imaging is important in the diagnosis.

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Surgical repair is the mainstay of treatment.

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Conservative management may be necessary in patients with excessive surgical risk.