Percutaneous Transapical Closure of a Left Ventricular Pseudoaneurysm

Abstract

Left ventricular pseudoaneurysm is a rare but serious complication after myocardial infarction, cardiac surgery or infection. Standard treatment is open surgery, however. percutaneous closure is an alternative in high risk patients. We report a case of percutaneous LV pseudoaneurysm closure via a direct transapical approach. A 76-year-old man with history of dementia and recent Staphylococcus aureus pericarditis returned for routine follow-up. He complained of NYHA class III dyspnoea and his transthoracic and transoesophageal echocardiogram showed a large LV pseudoaneurysm extending from the lateral and posterior aspect of the left ventricle, adjacent to the posterior mitral leaflet. It had a narrow neck measuring approximately 11 mm. The aneurysm cavity measured 60 x 40 x 60 mm. The patient and the family declined surgical intervention but agreed to a percutaneous intervention. Due to its position, a direct transapical approach was considered optimal. The transapical approach was planned with a pre-procedure cardiac CT scan and periprocedural fluoroscopy and TOE. Direct percutaneous puncture of the LV was made and a 7F Terumo sheath introduced. A 14 x 6 mm Amplatzer muscular VSD device was deployed in the neck of the aneurysm completely sealing the sac. The LV puncture was closed with Amplatzer ductus closure device. Surgical glue was injected into the delivery sheath to fill the track to the skin. There was no complication of the procedure and the patient was discharged on day 2. Direct percutaneous closure of LV pseudoaneurysm is a safe alternative to high risk surgery.