Late-presenting Left Ventricular Pseudoaneurysm Following Myocardial Infarction: A Rare Case Report

Left ventricular (LV) pseudoaneurysm is a myocardial rupture that has been sealed by pericardium, organised thrombus and fibrosis. A pseudoaneurysm has a 40%–50% risk of progressing to a full rupture, and thus warrants urgent surgical suturing. We present here a case report of a 63 years female who presented with this rare complication of myocardial infarction (MI). About three weeks prior, she had acute coronary syndrome (ACS)-non-ST elevation myocardial infarction (NSTEMI) and had undergone percutaneous transluminal angioplasty (PTCA) with a drug stent to the left anterior descending artery (LAD), and now came with retrosternal chest pain and breathing difficulty. A 2-D Echocardiogram was done, which showed a pseudoaneurysm in the mid left ventricle (LV) at the postero-lateral wall, approximately 3 centimetres (cms) from the mitral annulus, with dimensions of 5 × 8 × 8 cms. Doppler showed bidirectional flow. She underwent a successful surgery for pseudoaneurysmal repair with excision and pledgeted suture application. This case highlights the diagnostic challenges in the emergency department when a patient presents with symptoms of heart failure, along with astute clinical management astute clinical assessment and utility of multiple imaging techniques for imaging for timely intervention in such cases.