A Case of an Infected Right Ventricular Pseudo-False Aneurysm

A pseudo-false aneurysm is a rare complication of a myocardial infarction. This report describes our surgical experience with an extremely rare case of an infected right ventricular (RV) pseudo-false aneurysm. A 79-year-old woman with a history of steroid use for rheumatoid arthritis who was immobile for a few days presented to our hospital. She was in septic shock, so she was admitted to a critical care center, where antibiotics were initiated. Electrocardiography at the time of admission suggested an inferior wall myocardial infarction; however, given the patient's general condition, she was treated conservatively. After resolution of sepsis, transthoracic echocardiography and computed tomography revealed a mass shadow that suggested an RV pseudoaneurysm. Therefore, we performed pseudoaneurysm repair and coronary artery bypass of the left anterior descending branch. On opening the chest, we noted that the mass exhibited no adhesions to the pericardium or hematomas. The mass wall comprised firm tissue, while fragile tissue was observed inside. A pathological examination of the mass wall revealed myocardial tissue and Gram-positive cocci, with no findings suggestive of a myocardial infarction. Therefore, an infected RV pseudoaneurysm was diagnosed. The patient had an uneventful postoperative course and was discharged on postoperative day 40. Few reports of pseudo-false aneurysms are available, and most have described pseudoaneurysms in the left ventricle. To our knowledge, no reports have described pseudoaneurysms in the right ventricle. Therefore, cases like ours, which are associated with infection, are considered very rare.