Left ventricular pseudo-false aneurysm after ventricular septal dissection closure: a case report

Left ventricular pseudo-false aneurysm is a rare complication of myocardial infarction and generally caused by an intramyocardial dissecting hematoma due to a fragile myocardium. The serpiginous dissecting case of ventricular septal perforation has an entry port in the left ventricle and exit port in the right ventricle, and the entry port must be closed to leave the dissected chamber on the low-pressure right side for treatment. Herein, we report a case of a large left ventricular pseudo-false aneurysm that was unaccompanied by a shunt after the surgical repair of a ventricular septal dissection.

A 72-year-old woman underwent percutaneous coronary intervention to the right coronary artery; 3 days later, she was urgently referred to our hospital with ventricular septal perforation. The patient was treated with sandwich patch repair via a right ventricular incision. Postoperative transthoracic echocardiography revealed no residual shunt. However, 3 months postoperatively, enhanced chest computed tomography revealed a large left ventricular pseudo-false aneurysm bulging on the right ventricular side, causing congestive heart failure. An intra-aortic balloon pump was inserted for treatment. In our case, the left ventricular pseudo-false aneurysm was caused by the closure of only the exit port in the right ventricle and insufficient closure of the entry port in the left ventricle during ventricular septal dissection. Therefore, we closed the entry port through a pseudo-false aneurysm using a Dacron patch during the second surgery.

Recognizing and identifying the ventricular septal dissection after myocardial infarction are crucial for providing the best treatment and surgical approaches. When ventricular septal dissection is treated using sandwich patch repair via a right ventricular incision, the entry port in the left ventricle must be securely closed with a large patch using transmural mattress sutures.