A giant pseudoaneurysm becoming apparent after cardiac resynchronisation therapy

Area of Science:

• Cardiology
• Cardiac Surgery
• Medical Imaging

Background:

• A 57-year-old male with coronary artery disease developed an inferior wall pseudoaneurysm post-myocardial infarction.
• Initial surgical repair (coronary bypass and pseudoaneurysm resection) was complicated by patch dehiscence and recurrence.
• Six years later, the patient presented with severe, drug-refractory heart failure (NYHA class IV) due to left ventricular dysfunction.

Purpose of the Study:

• To report a case of recurrent pseudoaneurysm in a patient undergoing cardiac resynchronisation therapy (CRT).
• To highlight the diagnostic challenges of pseudoaneurysm recurrence, particularly with preoperative echocardiography.

Main Methods:

• The patient received a biventricular pacemaker for cardiac resynchronisation therapy due to heart failure with left bundle branch block and low ejection fraction (12%).
• Post-CRT, clinical recovery and improved left ventricular function were observed.
• Echocardiography revealed a third recurrence of the inferior wall pseudoaneurysm.

Main Results:

• Successful implantation of a biventricular pacemaker led to significant clinical improvement and enhanced left ventricular function.
• Despite clinical recovery, a third pseudoaneurysm recurrence was identified post-CRT.
• Preoperative echocardiography failed to detect this third pseudoaneurysm recurrence.

Conclusions:

• Cardiac resynchronisation therapy can effectively improve left ventricular function and clinical status in advanced heart failure.
• Recurrent pseudoaneurysms pose a diagnostic challenge, as demonstrated by the failure of preoperative echocardiography to detect the third recurrence in this case.
• This case underscores the importance of considering pseudoaneurysm recurrence in patients with complex cardiac histories, even after successful CRT.