Abstract
A 72-year-old woman was diagnosed with infectious endocarditis and aortic valve insufficiency and underwent aortic valve replacement. Extracorporeal circulation was established with the arterial cannula in the ascending aorta and the venous cannulas in the superior and inferior venae cavae, and left ventricular venting was performed via the right superior pulmonary vein. Transthoracic echocardiography on postoperative Day 14 showed abnormal mosaic perfusion and a 21 × 8 mm, echo-free space in the left ventricular apex, which was identified as a pseudoaneurysm of the left ventricular apex. Due to the risk of aneurysm rupture, left ventriculoplasty was performed as a semi-urgent procedure. Intraoperatively, a ventricular aneurysm the size of the first joint of the thumb was found in the cardiac apex. The aneurysm wall consisted only of thickened epicardium. The resected aneurysm wall did not contain any inflammatory cell infiltration or bacterial mass, and myocardial tissues were absent. From the histopathological and electrocardiographic findings, this case was considered to represent endocardial muscle damage and a pseudoaneurysm caused by intraoperative left ventricular vent catheter placement via the right superior pulmonary vein. During open heart surgery, careful attention must be paid to avoid damaging the myocardium with the left ventricular vent catheter, and the possibility of perioperative pseudoaneurysm formation as a result of surgical procedures should be borne in mind when performing postoperative echocardiography.
