Multistage Interventional Management of Ventricular Septal Pseudoaneurysm After Inferior Myocardial Infarction

Background Ventricular septal pseudoaneurysm is a rare, life-threatening mechanical complication of acute myocardial infarction, arising from blood dissecting within the necrotic septum to form a false lumen. Case Summary A 75-year-old man developed a postinfarction ventricular septal pseudoaneurysm with a “single-inlet, dual-outlet” morphology 5 days after the primary percutaneous coronary intervention for inferior-wall infarction. A staged transcatheter strategy—occluding the larger outlet first, then the inlet 5 months later—achieved progressive hemodynamic improvement and favorable 18-month outcomes. Discussion This case highlights an under-recognized, high-risk entity and shows that anatomy-tailored staged closure is a viable alternative to high-risk surgery when single-stage repair is infeasible. Take-Home Messages Suspect postinfarction septal dissection in recurrent heart failure or new murmurs after myocardial infarction; imaging is key. In complex pseudoaneurysms, a staged outlet-first, then inlet closure strategy yields favorable long-term results.