Background: Left ventricular pseudoaneurysm (LVP) is a rare, life-threatening complication following acute myocardial infarction (AMI), characterized by a high risk of rupture and mortality. Distinguishing LVP from true ventricular aneurysms is critical for patient management. Pseudoaneurysms occur when a myocardial wall rupture is contained by the pericardium or scar tissue without involving myocardial tissue, affecting only a portion of the wall thickness. Such occurrences are notably less common than cardiac ruptures post-AMI, with a prevalence below 0.5%.
Case Presentation: We report the case of a 43-year-old male presenting with chest pain, dyspnea, dizziness, and episodes of arrhythmia, with symptoms persisting for approximately ten days. The patient exhibited a negative T wave on electrocardiography and elevated D-dimer levels. Despite a negative computed tomography pulmonary angiography for pulmonary embolism, an unexpected basal posterolateral wall outpouching of the left ventricle with a narrow neck and relatively wide apex was discovered. Furthermore, an apical 2-chamber transthoracic echocardiography revealed a defect in the LV basal wall, communicating with a secondary cavity on the posterolateral border and mild mitral regurgitation. A chest radiograph showed focal bulging of the left ventricular border.
Diagnosis: These findings led to the diagnosis of an incomplete rupture of the left ventricle, resulting in a pseudoaneurysm. Urgent surgical intervention was undertaken.
Conclusion: This case underscores the importance of considering LVP in patients with atypical presentations post-AMI. Precise diagnostic imaging is paramount in identifying this rare condition to prompt urgent surgical repair.
Inayat F, Ghani AR, Riaz I, Ali NS, Sarwar U, Bonita R, Virk HUH. Left ventricular pseudoaneurysm: An overview of diagnosis and management. J Investig Med High Impact Case Rep. 2018 Aug 2;6:2324709618792025. doi: 10.1177/2324709618792025. PMID: 30090827; PMCID: PMC6077878.
Frances C, Romero A, Grady D. Left ventricular pseudoaneurysm. J Am Coll Cardiol. 1998;32(2):557-61.
Bisoyi S, Dash AK, Nayak D, Sahoo S, Mohapatra R. Left ventricular pseudoaneurysm versus aneurysm: a diagnostic dilemma. Ann Card Anaesth. 2016 Jan-Mar;19(1):169-72. doi: 10.4103/0971-9784.173042. PMID: 26750696; PMCID: PMC4900369.
Torchio F, Garatti A, Ronco D, Matteucci M, Massimi G, Lorusso R. Left ventricular pseudoaneurysm: The niche of post-infarction mechanical complications. Ann Cardiothorac Surg. 2022 May;11(3):290-8. doi: 10.21037/acs-2022-ami-25. PMID: 35733717; PMCID: PMC9207692.
Komeda M, David TE. Surgical treatment of postinfarction false aneurysm of the left ventricle. J Thorac Cardiovasc Surg. 1993;106(6):1189-91. doi: 10.1016/S0022-5223(19)33997-2.
Pujari SH, Agasthi P. Left ventricular rupture. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 [updated 2023 Jun 12]. Available from: https://www.ncbi.nlm.nih.gov/books/NBK559271/
Mourabiti AY, Alami BE, Bouanani Z, Houssaini MS, El Bouardi N, Haloua M, et al. A case of a giant left ventricular pseudoaneurysm. Radiol Case Rep. 2021 Oct;16(10):2920-3.
Zhong Z, Song W, Zheng S, Liu S. Surgical and conservative treatment of post-infarction left ventricular pseudoaneurysm. Front Cardiovasc Med. 2022 Jan 27;9:801511.
Robbins SL, Kumar V, Abbas AK, et al. Robbins and Cotran pathologic basis of disease. 8th ed. Philadelphia (PA): W.B. Saunders Company; 2010.
Camaj A, Fuster V, Giustino G, Bienstock SW, Sternheim D, Mehran R, et al. Left ventricular thrombus following acute myocardial infarction: JACC state-of-the-art review. J Am Coll Cardiol. 2022 Mar 15;79(10):1010-22.
Damluji AA, Van Diepen S, Katz JN, Menon V, Tamis-Holland JE, Bakitas M, et al. Mechanical complications of acute myocardial infarction: A scientific statement from the American Heart Association. Circulation. 2021 Jul 13;144(2)
Abbood A, Al Salihi H, Olivier M, Khawaja F, Madruga M, Carlan SJ. Left ventricular pseudoaneurysm and left ventricular thrombus in a patient presenting with an acute ST-elevation myocardial infarction. Am J Case Rep. 2022;23
Klein LR, Gautam RS, Beeman W, Smith SW. Electrocardiographic criteria to differentiate acute anterior ST-elevation myocardial infarction from left ventricular aneurysm. Am J Emerg Med. 2015;33(6):786-90. doi: 10.1016/j.ajem.2015.03.044.
Collet J-P, Thiele H, Barbato E, Barthélémy O, Bauersachs J, Bhatt DL, et al. ESC guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation. Eur Heart J. 2020;41(3):179-94. doi: 10.1093/eurheartj/ehaa575.
