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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
PubMed

Insights

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.

Keywords:
Rubidium-82 positron emission tomography computed tomographyacute myocardial infarctionaortic root reconstructionendocarditis surgeryleft main coronary artery compressionmyocardial perfusion imaging

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