Giant ventricular pseudoaneurysm and associated eccentric severe mitral regurgitation: Surgery or follow-up?

A ventricular pseudoaneurysm develops mainly after myocardial infarction complicated by a ventricular free wall rupture contained by localized pericardial adhesions. The risk of rupture in untreated pseudoaneurysms is approximately 30%-45%, and the mortality rate is 50%. Although there is no clear evidence of treatment in the literature, the main suggestion is to perform surgical treatment without delay. However, the age of the patients, additional comorbidities, and the accompanying severe mitral regurgitation and left ventricular systolic dysfunction considerably increase the mortality rate of the surgical procedure. The treatment of left ventricular pseudoaneurysm accompanied by severe mitral regurgitation has not been clarified in the literature, and patient-based individual approaches vary. In this case report, the clinical course of the three patients was explained with different treatment approaches, and we tried to create a resource for treatment approaches in light of the literature.