Left ventricular pseudo-aneurysm following cardiac surgery—two cases managed with two different techniques

Abstract

We report the clinical presentation, diagnosis, and management of two cases of left ventricular pseudo-aneurysm (LVPA) following left ventricular repair surgeries. The first patient, 46-year-old male, presented with New York Heart Association (NYHA) Class III symptoms at 2 months post-repair of acute posterior post-infarction ventricular septal rupture. Large posterolateral LVPA was detected. Surgical repair was done through a left thoracotomy by bovine pericardial patch closure of the defect under femoro-femoral cardiopulmonary bypass, moderate hypothermia, and without aortic cross clamping. The second patient, 57-year-old male, presented with NYHA Class III symptoms 36 months after he underwent repair of sub-mitral aneurysm along with mitral valve replacement and two vessel coronary artery bypass. Large posterolateral LVPA was detected with a 21-mm defect having good edges. He was managed by a hybrid procedure where a small thoracotomy exposed the aneurysmal sac and the defect was closed with a ventricular septal defect (VSD) device (Lifetech) inserted through a purse string on the aneurysmal sac under transesophageal echocardiography (TEE) guidance. Patients undergoing surgical repairs through left ventriculotomy should be carefully followed up for the occurrence of LVPA. The management depends on the site and size of the defect on the ventricular wall.