Case description
A 55-year-old man with a 2-week history of chest pain was transferred to our hospital. Electrocardiogram showed ST elevation in the inferior leads, and transthoracic echocardiography (TTE) revealed akinesis and thinning of the left ventricular (LV) posterior wall, with a small amount of pericardial effusion (Panel A). Emergency coronary angiography revealed total occlusion in the left circumflex artery. Two drug-eluting stents were implanted. Repeat TTE showed expansion of the LV posterior aneurysm (Panel B). The patient suddenly collapsed at the bedside 2 weeks after admission. Bedside TTE revealed cardiac tamponade. Emergency pericardiocentesis was performed immediately, followed by surgical patch repair for LV free wall rupture. The patient remained in a critical condition despite the successful operation, but could eventually be discharged. However, chest radiography performed 7 months after the operation showed enlargement of his heart. TTE showed a large echo-free space next to the LV posterolateral wall (Panel C). Color Doppler demonstrated to-and-fro jet flows between the echo-free space and the LV chamber. Cardiac computed tomography confirmed the presence of the LV pseudoaneurysm, which was larger than the LV chamber (Panel D, see Supplementary data online, Video S1), and turbulent jets (Panel E, arrows, and see Supplementary data online, Video S2). Successful suture closure was performed.
LV pseudoaneurysm is a rare complication after LV patch repair for free wall rupture. Patch repair failure sometimes occurs, because the ischaemic myocardium is fragile in the acute phase. A careful follow-up is necessary even in a patient with successful patch repair.
Conflict of interest: none declared.
Supplementary data are available at European Heart Journal—Cardiovascular Imaging online.