Multistage Interventional Management of Ventricular Septal Pseudoaneurysm After Inferior Myocardial Infarction
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Published on: February 11, 2022
Haibin Jiang1, Lei Li1, Hao Chen1
1Department of Cardiology, Wuxi No. 2 People's Hospital (Jiangnan University Medical Center), Wuxi, Jiangsu, China.
Background:
Ventricular septal pseudoaneurysm is a rare, life-threatening mechanical complication of acute myocardial infarction, arising from blood dissecting within the necrotic septum to form a false lumen.
Case Summary:
A 75-year-old man developed a postinfarction ventricular septal pseudoaneurysm with a "single-inlet, dual-outlet" morphology 5 days after the primary percutaneous coronary intervention for inferior-wall infarction. A staged transcatheter strategy-occluding the larger outlet first, then the inlet 5 months later-achieved progressive hemodynamic improvement and favorable 18-month outcomes.
Discussion:
This case highlights an under-recognized, high-risk entity and shows that anatomy-tailored staged closure is a viable alternative to high-risk surgery when single-stage repair is infeasible.
Take-Home Messages:
Suspect postinfarction septal dissection in recurrent heart failure or new murmurs after myocardial infarction; imaging is key. In complex pseudoaneurysms, a staged outlet-first, then inlet closure strategy yields favorable long-term results.
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