Multimodality Imaging-Guided Transseptal Closure of an Iatrogenic Left Ventricular Pseudoaneurysm

Left ventricular (LV) pseudoaneurysm is a rare but potentially fatal complication, typically resulting from a contained rupture of the LV free wall after myocardial infarction or cardiac surgery.

We report the case of a 65-year-old woman in whom a giant LV pseudoaneurysm was incidentally identified, likely as a late consequence of pericardiocentesis. Multimodality imaging, including cardiac computed tomography and transesophageal echocardiography, was essential for diagnosis and procedural planning. Given the patient's comorbidities and anatomic suitability, the heart team opted for percutaneous closure. A transseptal approach was used, with real-time computed tomography fluoroscopy fusion imaging to guide deployment of an Amplatzer muscular ventricular septal defect occluder. The intervention was successful, achieving complete exclusion of the pseudoaneurysm.

This case illustrates the feasibility and safety of transcatheter closure in high-risk patients.

Percutaneous closure guided by fusion imaging is a viable alternative for managing LV pseudoaneurysms in high-risk surgical candidates.