Giant pseudoaneurysm on left ventricular posterolateral wall with an orifice between papillary muscles

A left ventricular pseudoaneurysm develops when myocardial rupture is contained by the pericardium. Although left ventricular pseudoaneurysm has been a topic of discussion since the pioneering days of open heart surgery, it still remains a technical challenge in reconstructive cardiac surgery. Reoperation following pseudoaneurysm repair is also frequent. We report surgical treatment in two patients with a pseudoaneurysm on the left ventricular posterolateral wall. The pseudoaneurysm and left ventricular cavity communicated at a point just between the anterolateral and posteromedial papillary muscle attachments. Such a manifestation is highly infrequent but potentially lethal. During aneurysmectomy, special attention was paid to avoid the development of mitral regurgitation because the papillary muscle geometry changes after removal of the pseudoaneurysm. In both cases, surgical decision-making was facilitated by preoperative assessment using electrocardiographic-gated multislice computed tomography.