Left Ventricular Pseudoaneurysm Complicated With Very Late Rupture 5 Years After Myocardial Infarction

Abstract

This is a case of a chronic left ventricular pseudoaneurysm after inferior myocardial infarction that remained clinically silent for 5 years before presenting with sudden rupture, leading to hemopericardium and cardiac tamponade. We discuss the importance of surveillance for left ventricular pseudoaneurysms, the limitations of echocardiography, and the critical role of computed tomography angiography imaging to establish the diagnosis and guide therapy. ( Level of Difficulty: Beginner. )

Left ventricular pseudoaneurysm complicating acute inferoposterior myocardial infarction

“…The improved medical and the interventional management of acute MI have decreased the incidence of LV PSA. The incidence of LV PSA after MI is 0.2 to 0.3% [3]. The most common cause of LV PSA is transmural MI [4].…”

“…The risk of rupture is as high as 30-45% if left untreated [6]. The inferior or inferolateral walls are the most common site of LV PSA and the risk factors for its development are advanced age, female sex, hypertension, first MI, lack of collaterals, late presentation of MI, and delayed or no revascularization [3].…”

Left Ventricular Pseudoaneurysm - A Complication of Acute Myocardial Infarction

“…1 Among its etiologies, cardiac surgery, trauma, infectious endocarditis and myocardial infarction stand out, the latter being the main cause involved. 2,3 It has a variable and insidious clinical presentation, developing in individuals with or without previous clinical events, especially in patients with acute myocardial infarction (AMI) due to involvement of the inferior wall. 4,5 The surgical approach is an important therapy in view of the inherent complications.…”

Medical Management of a Case of Inferior-Posterior Wall ST Elevation Myocardial Infarction Complicated by Pseudoaneurysm

“…It can be associated with high morbidity and mortality when symptomatic, and is usually managed aggressively to prevent or reduce the risk of mortality. The incidence of pseudoaneuryms is reportedly as low as <0.3% [1,2]. When they occur, mortality can be as high as 40% with complications such as rupture and potentially fatal cardiac tamponade, thromboembolism, focus of infection, and arrhythmia [3].…”

“…When they occur, mortality can be as high as 40% with complications such as rupture and potentially fatal cardiac tamponade, thromboembolism, focus of infection, and arrhythmia [3]. Despite the natural history of rare complications with pseudoaneurysms, it is important to note that pseudoaneurysms can present with coronary artery disease and congestive heart failure, and clinicians need to have an index of suspicion for pseudoaneurysms despite advancement in medical and interventional management of coronary artery disease [2]. This will help reduce morbidity and mortality in these patients.…”