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Acute Infarction Due to Extrinsic Coronary Compression by Left Ventricular Pseudoaneurysm Following Endocarditis
Lars Niclauss1, Mario Verdugo1, Matthaios Papadimitriou Olivgeris2
1Department of Cardiovascular Surgery, University Hospital of Lausanne (CHUV), Lausanne CH-1011, Switzerland.
Interdisciplinary Cardiovascular and Thoracic Surgery
|April 23, 2026
Summary
Extrinsic coronary compression from a pseudoaneurysm is a rare but serious condition. Early imaging and prompt surgical intervention are crucial for survival in patients with myocardial ischemia.
Area of Science:
- Cardiology
- Cardiovascular Surgery
- Diagnostic Imaging
Background:
- Extrinsic coronary compression is a rare condition with severe consequences.
- A patient with a history of aortic valve endocarditis and septal abscess repair developed myocardial infarction.
Purpose of the Study:
- To report a case of extrinsic coronary compression caused by a pseudoaneurysm.
- To highlight the diagnostic challenges and management of this rare condition.
- To emphasize the importance of early imaging and surgical intervention.
Main Methods:
- Computed Tomography (CT) scan for anatomical assessment.
- Positron Emission Tomography (PET) for functional evaluation of myocardial perfusion.
- Surgical reoperation for decompression and repair.
Main Results:
- CT revealed left main stem compression due to a pseudoaneurysm under a surgical patch.
- PET confirmed acute left ventricular hypoperfusion.
- High-risk reoperation was performed, leading to recovery.
- One-year follow-up showed complete thrombosis of the abscess cavity.
Conclusions:
- Extrinsic coronary compression from abscess/pseudoaneurysm carries a high mortality rate.
- Surgical treatment is the primary life-saving option.
- Early quantitative myocardial perfusion imaging is recommended for unclear cardiac symptoms suggesting extrinsic coronary compression to determine surgical urgency.
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