Abstract 12152: Recurrent Cerebrovascular Accidents Following Myocardial Infarction With Mechanical Rupture

Abstract

Background: Mechanical complications of myocardial infarction (MI), including ventriculoseptal ruptures (VSR) and pseudoaneurysms, are potentially life-threatening events but are less common in the era of timely primary percutaneous coronary interventions. Rare case reports describe MI complicated by VSR requiring repair, with delayed left ventricular (LV) pseudoaneurysm formation from the site of VSR repair. We present an atypical manifestation of one such case. Case Presentation: A 55-year-old male was admitted with late presentation inferior MI complicated by inferior VSR, requiring extracorporeal membrane oxygenation and surgical repair. Five months later, he was admitted with left upper extremity weakness and sensory loss. Brain imaging revealed an acute infarct of the precentral gyrus and subacute punctate infarcts of the centrum ovale. He was referred for cardiac magnetic resonance imaging, which revealed a large 6.8x4.9 cm inferior LV pseudoaneurysm containing a large thrombus (Figure 1). He underwent urgent surgery revealing a left ventricular inferior wall defect (Figure 2) and pseudoaneurysm with large mural thrombus. The pseudoaneurysm was successfully repaired via Dacron patch placement and thrombus evacuated. Conclusion: Although less common in the modern era, mechanical complications are possible after severe MI. Clinicians should be aware of the potential for atypical manifestations of these complications, including cardioembolic events that can arise within large pseudoaneurysms.