Left Ventricular Pseudoaneurysm Following Anterior Myocardial Infarction

Abstract Left ventricular pseudoaneurysm (LVP) is a rare but severe mechanical complication of myocardial infarction (MI), associated with high risk of rupture and mortality. Accurate diagnosis relies on multimodality imaging, and timely surgical repair remains the mainstay of treatment. We report the case of a 78-year-old man, a former heavy smoker, who presented with progressive exertional dyspnea and bilateral lower limb edema. The electrocardiogram showed sequelae of a prior anterior MI with suspected aneurysmal evolution. Transthoracic echocardiography revealed a dilated left ventricle with severely impaired systolic function (left ventricular ejection fraction LVEF –20%) and a dyskinetic, aneurysmal apex. Coronary angiography showed two-vessel disease, while cardiac magnetic resonance confirmed a nonacute transmural infarction of the anterior and septal walls complicated by a large pseudoaneurysm with mural and extramural thrombus. Because of the high risk of progression and embolic complications, the patient underwent elective surgical repair with an endoventricular circular patch plasty (Dor procedure). The postoperative recovery was uneventful. At 2-weeks, echocardiography showed a favorable left ventricular (LV) remodeling, with an important reduction in end-diastolic volume (from 230 to 150 mL), and a marked improvement in systolic function (LVEF from 20% to 39%). This case highlights the critical role of imaging in diagnosing and characterizing LVP, as well as the therapeutic efficacy of surgical ventricular reconstruction. Early surgical intervention can prevent catastrophic rupture and restore LV geometry, improving global systolic performance. Multidisciplinary evaluation is essential to guide management, and less invasive percutaneous approaches may represent future alternatives in high-risk surgical candidates.