In a 62-year-old man, pericardial adhesions from a prior coronary bypass surgery contained a left ventricular free wall rupture 2 weeks after an acute myocardial infarction, preventing collapse.
Case Report (n=1)
Previous surgical pericardial adhesions can contain a left ventricular free wall rupture after an acute MI, forming a pseudoaneurysm and providing a window for surgical intervention guided by multimodality imaging.
BACKGROUND: Fatal mechanical complications of acute myocardial infarctions include free wall rupture and ventricular septal rupture. If pericardial adhesions wall off a free wall rupture, it may lead to formation of pseudoaneurysms that are characterized by a narrow mouth. Even though pseudoaneurysms are common after myocardial infarctions, they may also occur following surgery, trauma, and infections rarely. CASE SUMMARY: We present a case of a 62-year-old man who developed a left ventricular pseudoaneurysm 2 weeks after thrombolysis for an acute inferolateral myocardial infarction. Multiple non-invasive imaging modalities demonstrated the anatomy, regional and global ventricular function, distortion of mitral annulus by the eccentric large aneurysm. Pericardial scars after a previous coronary bypass surgery contained this left ventricular free wall rupture and helped in providing a safe window period for corrective surgery. DISCUSSION: While left ventricular pseudoaneurysms that develop following myocardial infarctions warrant emergency surgery due to the high impending chances of rupture and tamponade, previous surgical pericardial adhesions guarded against an imminent collapse. Multimodality imaging of the aneurysm helped in planning the surgical strategy.
Singh et al. (Tue,) conducted a case report in Left ventricular pseudoaneurysm (n=1). Multimodality imaging and corrective surgery was evaluated. In a 62-year-old man, pericardial adhesions from a prior coronary bypass surgery contained a left ventricular free wall rupture 2 weeks after an acute myocardial infarction, preventing collapse.