Post–myocardial infarction left ventricular aneurysm rupturing into the right ventricle

Left ventricular pseudoaneurysm is a rare but life-threatening complication that may occur following myocardial infarction, cardiac surgery, or trauma. It develops when a myocardial rupture is contained by fibrous scar tissue or pericardial adhesions, often leading to marked hemodynamic instability. This report describes a 62-year-old man who developed a left ventricular pseudoaneurysm with rupture into the right ventricle following myocardial infarction. Coronary angiography identified the right coronary artery as the culprit coronary artery, defined as the specific coronary vessel that had developed the acute obstructive lesion responsible for the infarction, and balloon angioplasty was performed. Although initial echocardiograms failed to detect the rupture, subsequent multi-angle echocardiographic evaluation established the diagnosis. The patient underwent successful surgical intervention, including repair of the left ventricular rupture and ventricular septal perforation, along with excision of the pseudoaneurysm. A representative intraoperative procedural image was added to illustrate the operative findings and repair. In addition, postoperative chest computed tomography (CT) was performed and demonstrated satisfactory postoperative changes without evidence of residual pseudoaneurysm. Postoperative recovery was uneventful, and serial follow-up assessments confirmed stable cardiac function. This case highlights the critical importance of thorough diagnostic imaging for detecting cardiac complications, particularly pseudoaneurysms, for which early diagnosis is often challenging.