A Unique Complication of a Broken Heart

Left Ventricular Pseudoaneurysm Due to Embolic Myocardial Infarction in Infective Endocarditis: Real Time Three-Dimensional Transesophageal Echocardiographic Evaluation

“…Myocardial infarction is the leading cause, followed by cardiac surgery (valve surgery, aneurysmectomy, and apical venting), trauma, infection, and rarely, ablation procedures. [1][2][3] In this case, a small fragment of mitral vegetation presumably embolized to the distal LAD and caused transmural infarction of the apex with subsequent rupture and formation of a PA. Septic coronary embolism was a relatively common finding in older necropsy studies of IE. 4 Brunson 4 reported small miliary myocardial infarcts in 111/183 (60%) and noted small coronary emboli in 72/183 (40%) cases in a large necropsy study.…”

“…LV PA is a rare lesion that develops when a cardiac rupture is contained by the overlying pericardium. Myocardial infarction is the leading cause, followed by cardiac surgery (valve surgery, aneurysmectomy, and apical venting), trauma, infection, and rarely, ablation procedures 1–3 . In this case, a small fragment of mitral vegetation presumably embolized to the distal LAD and caused transmural infarction of the apex with subsequent rupture and formation of a PA. Septic coronary embolism was a relatively common finding in older necropsy studies of IE 4 .…”

“…2 and 3). 1–3 Surgical repair is recommended due to a higher likelihood of spontaneous rupture. Surgical repair was done under intraoperative TEE guidance with excellent outcome.…”