CASE REPORT 250 Case Reports Heart, Lung and Circulation 2008;17:243–263 4. Holstege C, Baer A, Brady WJ. The electrocardiographic tox- idrome: the ECG presentation of hydrofluoric acid ingestion. Am J Emerg Med 2005;23(2):171–6. 5. Cordero SC, Goodhue WW, Splichal EM, Kalasinsky VF. A fatalitiy due to ingestion of hydrofluoric acid. J Anal Toxicol 2004;28:211–3. 6. Singal PK, Iliskovic N. Doxorubicin-induced cardiomyopathy. N Engl J Med 1998;339(13):900–5. 7. Fernandez-Sola J, Estruch R, Grau JM, Pance JC, Rubin E, Urbano-Marquez A. The relation of alcoholic myopathy to car- diomyopathy. Ann Intern Med 1994;120:529–36. Percutaneous Closure of Left Ventricular Free Wall Rupture with Associated False Aneurysm to Prevent Cardioembolic Stroke Wil Harrison, MBChB a,∗ , Peter N. Ruygrok, FRACP a , Sally Greaves, FRACP a , Namal Wijesinghe, MD, MRCP b , Hamish Charleson, FCSANZ b and Clyde Wade, FRACP b Gerard Devlin, FRACP b a Greenlane Cardiovascular Service, Auckland City Hospital, Auckland, New Zealand b Department of Cardiology, Waikato Hospital, Hamilton, New Zealand Left ventricular (LV) false aneurysm is an uncommon complication of myocardial infarction. Conventional treatment mandates surgical repair but is associated with significant perioperative risk. We present a case of successful percutaneous closure of a LV false aneurysm in a patient at high operative risk who suffered cardioembolic stroke related to thrombus within the aneurysm. The primary aim of treatment was to prevent recurrent embolic event. (Heart, Lung and Circulation 2008;17:243–263) © 2007 Australasian Society of Cardiac and Thoracic Surgeons and the Cardiac Society of Australia and New Zealand. Published by Elsevier Inc. All rights reserved. Keywords. Left ventricular false aneurysm; Percutaneous closure; Stroke; Amplatzer Introduction L eft ventricular (LV) false aneurysm formation occurs when a rupture in the myocardium is contained by pericardium or scar tissue. 1 The largest reported series of 290 patients identified myocardial infarction (MI) as the most common cause, responsible for just over half of all cases. 2 In this setting, false aneurysm was twice as common with inferior compared to anterior infarcts. The reason for this predilection is uncertain but could be due to the higher likelihood of anterior LV wall rupture to result in haemopericardium and death. 3 Previous cardiac surgery accounts for a third of cases, mitral valve replacement being the most common antecedent procedure. Trauma, infection and previous cardiac catheterisation 4 have also been implicated. The risk of false aneurysm rupture if left untreated is between 30% and 50%. 2,5,6 Conventional management Received 27 November 2006; received in revised form 17 April 2007; accepted 18 April 2007; available online 11 September 2007 ∗ Corresponding author at: Greenlane Cardiovascular Service, Level 3 Auckland City Hospital, Private Bag 92-024, Auckland 1, New Zealand. Tel.: +64 9 307 4949; fax: +64 9 307 4950. E-mail address: wharriso@middlemore.co.nz (W. Harrison). is with surgical repair, but this procedure has an asso- ciated mortality of approximately 23%. 2 The advent of percutaneous closure devices provides an alternative management option in those patients who are haemody- namically stable but at high operative risk. We present a case of successful percutaneous closure of a LV false aneurysm in a patient at high operative risk who suffered cardioembolic stroke related to thrombus within the aneurysm. The primary aim of treatment was to prevent recurrent embolic event, the secondary objective being to reduce the risk of aneurysm rupture. Case History A 47-year-old Caucasian female presented to hospital with an acutely ischaemic right leg caused by femoral artery thrombus. Embolectomy was successfully performed. At this time electrocardiographic evidence of previous inferior MI was established. Transthoracic echocardio- gram (TTE) showed thinning and akinesis of the basal inferior LV wall and coronary angiography showed an occluded mid-right coronary artery. The aetiology of the embolism was presumed to be mural thrombus. She was treated medically, which included anticoagulation with warfarin. © 2007 Australasian Society of Cardiac and Thoracic Surgeons and the Cardiac Society of Australia and New Zealand. Published by Elsevier Inc. All rights reserved. 1443-9506/04/$30.00 doi:10.1016/j.hlc.2007.04.009