Acquired Annular Subvalvular Aneurysm Complicated by a Fistulous Tract

We report a case of an annular subvalvular left ventricular aneurysm in a 60-year-old Caucasian woman with a history of rheumatoid arthritis, hypertrophic cardiomyopathy and methicillin-resistant Staphylococcus aureus bacteremia. Initial transthoracic echocardiography failed to identify the aneurysm, but trans-esophageal echocardiography and cardiac magnetic resonance imaging confirmed the diagnosis. The patient underwent repair of left ventricular pseudoaneurysm with bovine pericardium patch and is doing well postoperatively with residual pulmonary hypertension, left ventricular intracavitary gradient, and right ventricular dysfunction.