Abstract
Left ventricular pseudoaneurysm is an uncommon complication after transmural myocardial infarction, occurring when a free wall rupture is contained by adhesions of the overlying pericardium preventing acute tamponade. In this report, an unusual case of a 61 year-old male with a giant apical left ventricular pseudoaneurysm after an unnoticed myocardial infarction is presented. On coronary angiogram myocardial bridging of the distal left anterior descending artery was judged to be the infarct related lesion. The echocardiographic diagnosis allowed for a timely surgical intervention which resulted in the patient's full recovery.
Highlights
Most left ventricular pseudoaneurysms are caused by myocardial infarction
The natural history of acquired left ventricular pseudoaneurysms is not perfectly known, it is accepted that the danger of secondary fatal rupture is high for large or expanding pseudoaneurysms or when the diagnosis is made within the first month after the causal event
Though left ventricular pseudoaneurysm formation after myocardial infarction has become a less common event in the era of reperfusion therapy, its diagnosis and management still represents a challenge in the light of its potentially catastrophic consequences
Summary
Most left ventricular pseudoaneurysms are caused by myocardial infarction. Other causes are cardiac surgery, trauma and infection. Surgical repair of pseudoaneurysms after myocardial infarction is associated with an important, though acceptable, risk of complications with most patients needing concomitant coronary artery bypasses for significant stenoses [4,5] We report this case because of the unusual features of the left ventricular pseudoaneurym itself (volume, location, "mushroom cloud" appearance), and because of the rarity of its association with myocardial bridging, the presumed cause of the unnoticed myocardial infarction. Cardiovascular Ultrasound 2009, 7:36 http://www.cardiovascularultrasound.com/content/7/1/36 days earlier he had been evaluated at the emergency department for sustained pleuritic chest pain with shortness of breath, a chest X-ray and blood analysis were performed, and he was discharged on antibiotics with a presumptive diagnosis of pneumonia He was re-admitted with progressive, worsening symptoms and presented with sinus tachycardia (115 beats/min), low blood pressure (82/59 mmHg), a grade 2/6 systolic ejection murmur at the left sternal border and basal rales. Ten months after the operation the patient remains on medical therapy, free of angina and cardiac events
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