Left ventricular pseudoaneurysm in a patient with Dressler's syndrome after myocardial infarction

Successful recanalisation of the left anterior descending coronary artery was performed in a 51 year old man who was admitted two weeks after acute anterior myocardial infarction. Fourteen days later, the patient developed Dressler's syndrome with cardiac tamponade, which was immediately punctured. Sternotomy was performed after two weeks because of progressive haemodynamic deterioration, and fibrinous masses were removed from the pericardium. The patient recovered but two weeks later echocardiography showed a perforation of the left ventricular free wall and formation of a pseudoaneurysm. Intensive monitoring showed significant enlargement of the pseudoaneurysm, which was subsequently resected. This case demonstrates that dangerous formation of a pseudoaneurysm can occur not only during the first days of acute myocardial infarction but also after weeks in patients suffering from non-infectious pericarditis caused by Dressler's syndrome. Although the incidence of Dressler's syndrome is declining, patients should be monitored carefully for several weeks, especially by echocardiography.