Giant Left Ventricular Pseudoaneurysm 10 Years After Post-Infarct Ventricular Septal Defect Repair

A 51-year-old man developed acute inferior myocardial infarction complicated by impending left ventricular (LV) rupture and post-infarct ventricular septal defect (VSD), for which he underwent surgical VSD patch closure, LV repair, and revascularization to the coronary arteries. He remained well for the subsequent 10 years as an outpatient until he was admitted to hospital because of dyspnea on effort. Transthoracic echocardiography revealed advanced LV remodeling and an incidental LV aneurysm (Supplementary Movie 1). Cardiac computed tomography confirmed a giant LV pseudoaneurysm (70×100×100 mm) communicating with the inferior LV through a large orifice (diameter, 80 mm) (Figure A–C, Supplementary Movie 2). The orifice, which had been formed by detachment of the patch from the surrounding LV muscle, was closed with a bovine pericardial patch (Figure D,E). Postoperative examinations showed successful LV pseudoaneurysm repair without leakage through the patch and a completely thrombosed aneurysmal sac (Figure F).

Figure.

Preoperative cardiac computed tomography showing the inferior LV pseudoaneurysm (70×100×100 mm) (A–C). Its large orifice (diameter, 80 mm) was closed with a bovine pericardial patch (D,E). Postoperative contrast-enhanced computed tomography showing thrombosed aneurysmal sac (white arrowheads) (F). LA, left atrium; LV, left ventricle; RV, right ventricle.

LV pseudoaneurysm is a rare complication following myocardial infarction; however, the high risk of rupture and heart failure necessitates surgical repair.¹ In conclusion, delayed presentation 1 decade after myocardial infarction, as observed in the present case, is extremely rare. Understanding this late complication and periodic screening are mandatory for diagnosis and appropriate management of such cases.

Disclosures

None of the authors has any financial conflicts of interest or grants to disclose. Y.S. is a member of Circulation Journal’s Editorial Team.

IRB Information

The Institutional Review Board of Osaka University Hospital (approval no. 16105; approval date, 2016/2/11) approved this paper, and written informed consent was given by the patient for the use of records. The procedures followed were in accordance with the Declaration of Helsinki.

Supplementary Files

Supplementary Movie 1.

Supplementary Movie 2.

Please find supplementary file(s);

http://dx.doi.org/10.1253/circj.CJ-21-0895

Reference

• 1.   Yeo TC, Malouf JF, Oh JK, Seward JB. Clinical profile and outcome in 52 patients with cardiac pseudoaneurysm. Ann Intern Med 1998; 128: 299–305.