Why the study?
Left ventricular pseudo-false aneurysm is a rare complication secondary to myocardial infarction caused by intramyocardial dissecting hematoma, with very rare occurrence in the anterior wall and subacute rupture.
Case Report (n=1)
No
This case illustrates the successful surgical management of an extremely rare and potentially fatal left ventricular anterior wall pseudo-false aneurysm rupture secondary to myocardial infarction.
May support bovine pericardial patch repair in rare LV pseudo-false aneurysm rupture; leaves open need for larger studies on durability and generalizability.
BACKGROUND: Left ventricular (LV) pseudo-false aneurysm is a rare complication secondary to myocardial infarction and is caused by intramyocardial dissecting hematoma due to fragile myocardium. Very occasionally, intramyocardial dissecting hematoma appears as a neocavitation entirely contained within the myocardial wall (so called "pseudo-false LV") and is an unusual form of subacute cardiac rupture. CASE PRESENTATION: A 38-year-old male experienced chest discomfort 3 weeks ago, which improved within few days. However, after that episode, he presented at our hospital with rapidly deteriorating severe breathlessness in a preshock state with acute heart failure. Emergency coronary angiography revealed an occluded left anterior descending artery. An intra-aortic balloon catheter was inserted because of unstable hemodynamics. Enhanced computed tomography revealed extensive aneurysm formation in the LV anterior wall and contrast leakage from the inner cavity to the LV myocardium, with a moderately accumulated pericardial effusion. Emergency surgery revealed a large aneurysmal sac on the anterior wall, slightly attached to the pericardium. A 5-mm, slit-like, oozing-type, rupture site was detected in the LV after dissecting the pericardium. CONCLUSIONS: To our knowledge, this is the first report of a pseudo-false aneurysm on the LV anterior wall. Subacute rupture of pseudo-false LV aneurysm is rare.
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Okada et al. (2019) conducted a case report in Ruptured left ventricular pseudo-false aneurysm secondary to subacute anterior myocardial infarction (n=1). Surgical repair with bovine pericardial patch was evaluated on Patient survival and clinical recovery.
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