Complete postsurgical left ventricular-aortic discontinuity and pseudoaneurysm formation

Area of Science:

• Cardiovascular Surgery
• Cardiac Imaging
• Infective Endocarditis

Background:

• Left ventricular outflow tract (LVOT) pseudoaneurysm is a rare, potentially fatal complication following aortic valve replacement, infective endocarditis (IE), and suture dehiscence.
• Complete left ventricular-aortic discontinuity is an uncommon and severe manifestation of IE, often resulting from ruptured periannular lesions in patients with a history of endocarditis.

Observation:

• A case of complete postoperative left ventricular-aortic discontinuity and massive circumferential LVOT pseudoaneurysm was identified during a 3-month follow-up.
• Cardiac computed tomography revealed dehiscence of a surgical aortic valve from the LVOT, with extensive pseudoaneurysm formation.

Findings:

• The patient presented with a complete left ventricular-aortic discontinuity, evidenced by a small remnant of the interventricular septum connecting the aortic root to the heart.
• Massive circumferential pseudoaneurysm formation was noted around the left ventricular outflow tract.

Implications:

• The clinical presentation of LVOT pseudoaneurysm with left ventricular-aortic discontinuity is often nonspecific or clinically silent.
• High index of suspicion and multimodality imaging are essential for accurate diagnosis and effective management of this rare complication.