Global akinesis: inadvertent left ventricular "pseudoaneurysmogram"

Area of Science:

• Cardiology
• Cardiac Surgery
• Medical Imaging

Background:

• Left ventricular pseudoaneurysms (PA) are uncommon complications following myocardial infarction (MI).
• The management of large post-MI PAs remains challenging, with unclear surgical versus medical therapy decisions.
• Widespread use of thrombolytic therapy and primary percutaneous coronary intervention has reduced the incidence of these complications.

Observation:

• A massive left ventricular pseudoaneurysm (PA) developed post-myocardial infarction.
• Initial cardiac catheterization misidentified the PA as a globally akinetic left ventricle.
• The patient's refusal of prior therapy may have contributed to the PA development.

Findings:

• A massive postinfarct left ventricular pseudoaneurysm was identified.
• Surgical intervention was recommended due to the necessity for concurrent coronary artery bypass grafting and mitral valve repair.
• Accurate diagnosis via review of the left ventriculogram was crucial.

Implications:

• This case underscores the importance of careful interpretation of cardiac imaging, especially in complex post-MI scenarios.
• It highlights the critical role of surgical intervention for large PAs requiring concomitant cardiac procedures.
• Understanding the potential for misdiagnosis in pseudoaneurysm identification is vital for patient management.