Key result
CMR-guided MVR and LV pseudoaneurysm repair enables successful discharge after delayed MI.
Why the study?
While the immediate medical complications of SARS-CoV-2 are well recognized, its indirect effects on patients and healthcare systems are potentially less perceivable.
Case Report (n=1)
No
Answers are grounded in this paper and cite their sources.
This case illustrates how pandemic-related healthcare avoidance and delayed AMI presentation can lead to rare, life-threatening mechanical complications such as left ventricular pseudoaneurysm and severe ischaemic mitral regurgitation, where cardiac MRI is critical for diagnosis and surgical planning.
BACKGROUND: Left ventricular pseudoaneurysm (LVP) is an uncommon but serious mechanical complication of acute myocardial infarction (AMI). The immediate medical complications of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) are well recognized, but its indirect effect on patients and healthcare systems is potentially less perceivable. CASE SUMMARY: In this report, a 72-year-old man who was anxious about attending hospital during the SARS-CoV-2 pandemic was eventually found to have a total right coronary artery occlusion after a delayed emergency department presentation. He ultimately developed severe symptomatic heart failure and cardiac magnetic resonance imaging (CMR) revealed that a large LVP with concomitant severe ischaemic mitral regurgitation had evolved from his infarct. The patient was successfully discharged home after the surgical replacement of his mitral valve and repair of his LVP. DISCUSSION: This case highlights a salient downstream effect of Coronavirus disease 2019 (COVID-19): the delay in presentation, diagnosis, and management of common treatable conditions such as AMI. It also underscores the importance of non-invasive multimodal imaging on the timely identification of the mechanical complications of AMI. In particular, CMR can play a crucial role in the characterization and management of LVP.
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Brennan et al. (2021) conducted a case report in Left ventricular pseudoaneurysm and severe ischaemic mitral regurgitation following delayed presentation of acute myocardial infarction (n=1). Surgical mitral valve replacement and direct closure repair of left ventricular pseudoaneurysm guided by cardiac magnetic resonance imaging was evaluated on Successful surgical repair and hospital discharge. Surgical mitral valve replacement and left ventricular pseudoaneurysm repair after CMR diagnosis enabled successful discharge 3 months post-surgery in a 72-year-old man with delayed MI presentation.
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