Evolution of a Pseudoaneurysm Due to Microvascular Obstruction in Myocardial Infarction Assessed by Cardiac Magnetic...

Ventricular pseudoaneurysm (PsA) is a rare but serious complication after acute myocardial infarction (MI) that can lead to heart failure, arrhythmias, thromboembolism, and death.

A PsA was diagnosed in a patient with an unrevascularized inferolateral MI. Cardiovascular magnetic resonance showed late gadolinium enhancement and microvascular obstruction, followed several weeks later by wall rupture and PsA formation.

A left ventricular PsA should be differentiated from a true aneurysm and other post-MI complications such as ventricular septal defect and Dressler syndrome. While transthoracic echocardiography is often sufficient for diagnosis, challenging cases may necessitate cardiovascular magnetic resonance or computed tomography to evaluate the site of the rupture, characterize the myocardial injury, determine the extent and size of the PsA, and assess its relationship to adjacent structures, all of which aid in surgical planning. Urgent surgical repair is recommended to reduce the risk of rupture of the PsA that can result in exsanguination and death.