Subacute left ventricular free wall rupture and pseudoaneurysm formation: a rare and catastrophic complication of left anterior descending artery occlusion

Left ventricular free wall rupture (LVFWR) is a rare but catastrophic mechanical complication of acute myocardial infarction (AMI), carrying a high mortality rate despite advances in reperfusion therapy. We report the case of a 60-year-old man, with a history of Bentall procedure, who presented with acute pulmonary edema five days after the onset of chest pain. Electrocardiography suggested a late-presenting anterior ST-segment elevation myocardial infarction, while coronary angiography demonstrated thrombotic occlusion of the ostial left anterior descending artery. Transthoracic echocardiography identified subacute LVFWR with pseudoaneurysm formation, and the diagnosis was confirmed by computed tomography. Owing to prohibitive surgical risk, conservative management was selected. The patient subsequently developed cardiogenic shock and died three days later. This case highlights the importance of early recognition of LVFWR using multimodality imaging and underscores the persistently poor prognosis of this rare but fatal mechanical complication of AMI.