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Unusual rupture of left ventricular pseudo-false aneurysm secondary to subacute anterolateral myocardial infarction:

Masaho Okada1, Hirotaka Watanuki2, Kayo Sugiyama2

  • 1Department of Cardiac Surgery, Aichi Medical University, 1-1 Yazakokarimata, Nagakute, Aichi, Japan. okmasaho123@gmail.com.

Journal of Cardiothoracic Surgery
|May 19, 2019
PubMed
Abstract

Insights

This case report describes a rare instance of subacute cardiac rupture, specifically a pseudo-false left ventricular aneurysm, following myocardial infarction. This condition, caused by intramyocardial dissecting hematoma, presents as a neocavitation within the heart wall.

Area of Science:

  • Cardiology
  • Cardiac Surgery
  • Cardiovascular Imaging

Background:

  • Pseudo-false left ventricular (LV) aneurysm is a rare complication of myocardial infarction.
  • It arises from intramyocardial dissecting hematoma due to fragile myocardium.
  • This entity can manifest as a neocavitation within the LV wall, representing subacute cardiac rupture.

Observation:

  • A 38-year-old male presented with acute heart failure and breathlessness weeks after initial chest discomfort.
  • Coronary angiography showed an occluded left anterior descending artery.
  • Enhanced CT revealed LV anterior wall aneurysm with contrast leakage and pericardial effusion.

Findings:

  • Emergency surgery identified a large aneurysmal sac on the LV anterior wall.
  • A 5-mm slit-like, oozing rupture site was found within the LV myocardium.
  • This represents the first reported case of a pseudo-false aneurysm on the LV anterior wall.

Implications:

  • Subacute rupture of a pseudo-false LV aneurysm is an exceedingly rare clinical event.
  • Prompt diagnosis and surgical intervention are crucial for managing such life-threatening cardiac complications.
  • This case underscores the importance of considering rare entities in the differential diagnosis of acute heart failure post-myocardial infarction.
Keywords:
Intramyocardial dissecting hematomaLeft ventricular pseudo-false aneurysmSubacute cardiac rupture

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