Abstract
A 74-year-old man who felt chest pain but let it alone 4 days earlier had chest pain again and was brought into our hospital by ambulance because of cardiogenic shock. Emergency coronary angiography (CAG) revealed complete occlusion of the left circumflex coronary artery (#13). Echocardiography showed thinning posterolateral wall of the left ventricle and large volumes of pericardial effusion. Acute myocardial infarction and cardiac tamponade due to left ventricle free wall rupture were diagnosed. Since several days had elapsed after the onset of the disease, percutaneous coronary intervension (PCI) appeared to entail a risk of reperfusion injury. We did not employ PCI and immediately performed pericardial drainage for cardiac tamponade. We could get through the acute stage with only conservative therapy, but echocardiography conducted 3 months later disclosed a 30-mm diameter left ventricular pseudoaneurysm at the posterolateral wall of the left ventricle. We were worry about rupture of the aneurysm and performed surgical left ventricular reconstruction and coronary artery bypass grafting as early as possible. The pseudoaneurysm comparatively firmly adhered to the surroundings and thrombus was present within the aneurysm.
Left ventricle free wall rupture (oozing type) requires not only treatment in the acute stage but also careful follow-up using echocardiography in the chronic stage by keeping a possible occurrence of ventricular pseudoaneurysm in mind. It is important to perform surgery as early as possible if a ventricular pseudoaneurysm occurs.
