Left ventricular pseudoaneurysm expansion without surgical treatment

Abstract

An 82-year-old man was admitted with acute inferior wall myocardial infarction and underwent successful percutaneous coronary intervention for the right coronary artery. Pre-discharge transthoracic echocardiogram revealed a dyskinetic cavity connected to the posterior left ventricular wall (Panel A). Cardiac magnetic resonance confirmed the presence of a pseudoaneurysm with a maximum internal end-systolic dimension of 1.5 × 2 × 1 cm (Panel B). Surgery was strongly recommended to the patient and his family but they declined.

One year later the patient was readmitted to the hospital with progressively worsening exertional dyspnoea. Chest X-ray revealed a rounded opacity silhouetting the left cardiac border (Panel C). Echocardiogram showed a great increase in the size of the pseudoaneurysm to ∼7 ×6 ×5 cm, which was communicating with the left ventricle through a 3-cm defect in the posterior left ventricular wall (Panels D and E, Supplementary data online, Video S1). The pseudoaneurysm was contained by a thin layer of visceral pericardium surrounded by thrombotic material in the pericardial space.