CASE REPORT Heart Vessels (2003) 18:160–162 © Springer-Verlag 2003 DOI 10.1007/s00380-003-0693-0 Hikmet Koçak · Necip Becit · Münacettin Ceviz Yahya Ünlü Left ventricular pseudoaneurysm after myocardial infarction Received: September 12, 2002 / Accepted: February 15, 2003 Abstract In this report, a case of a left ventricular (LV) pseudoaneurysm due to a previous myocardial infarction, which was repaired successfully, is described. A 62-year-old man, with a history of acute anterior wall myocardial infarc- tion 6 months previously, was admitted with the complaints of acute dyspnea and palpitation. Echocardiography re- vealed an LV aneurysm, and ventriculography showed ven- tricular dysfunction and an LV pseudoaneurysm. Coronary angiography showed total occlusion of the proximal seg- ment of the left anterior descending artery with a very thin lumen and insufficient retrograde filling. Under cardiopul- monary bypass and beating heart, the pseudoaneurysm was resected and the defect on the ventricular free wall was closed by the remodeling ventriculoplasty method of Dor. Histopathologic examination of the resected material con- firmed the diagnosis of pseudoaneurysm. The postoperative course of our patient was uneventful. He was discharged on the ninth postoperative day. Key words Left ventricle · Pseudoaneurysm · Myocardial infarction Introduction The development of a left ventricular (LV) pseudoan- eurysm is a rare disorder that usually occurs after transmu- ral myocardial infarction or cardiac surgery. 1–3 Free wall rupture usually results in cardiac tamponade and death. Less frequently, cardiac rupture is contained by adherent pericardium or scar tissue, and pseudoaneurysm of the left ventricle occurs. Thus, unlike a true LV aneurysm, an LV pseudoaneurysm contains no endocardium or myocardium. The natural history of a chronic pseudoaneurysm is not H. Koçak (*) · N. Becit · M. Ceviz · Y. Ünlü Department of Cardiovascular Surgery, Atatürk University, Medical Faculty, loj. No: 50/8, 25240 Erzurum, Turkey Tel. +90-442-316-6333 ext. 2141; Fax +90-442-316-6340 e-mail: hkocak54@hotmail.com clearly understood. However, the danger of secondary rup- ture is real for a large pseudoaneurysm, but uncertain for small ones. 2,4 Although LV pseudoaneurysm is clinically uncommon, the mortality rate is very high due to secondary rupture. 2–6 In this report, a case of a large LV pseudoaneurysm on the anterior wall due to a previous anterior myocardial infarction, which was repaired successfully, is described. Case report A 62 year-old man, who had experienced an anterior myo- cardial infarction 6 months previously, was admitted to our clinic with the complaints of acute dyspnea and palpitation. The patient was hospitalized with a diagnosis of congestive heart failure due to LV aneurysm. Chest X-rays showed that the heart was pathologically enlarged, primarily on the left, and exhibited an aberrant contour. An echocardiogram demonstrated left ventricular dysfunction, a large LV aneu- rysm containing a thrombus, and the ejection fraction (EF) was 30%. Transthoracic echocardiography did not provide more information for evaluation of an anterior ventricular pseudoaneurysm. Contrast left ventriculography showed ventricular dysfunction and an LV pseudoaneurysm. The pseudoaneurysm, containing a thrombus, was connected to the ventricle by a narrow neck, and the contrast medium tended to remain in the pseudoaneurysmal cavity for sev- eral beats after injection, consistent with the stagnant flow of blood in the sac (Fig. 1). Coronary angiography showed total occlusion of the proximal segment of the left anterior descending artery (LAD) with a very thin lumen, and its retrograde filling was TIMI grade-1. The other coronary arteries were normal. We considered the cause of the pseudoaneurysm to be left anterior descending artery oc- clusion. At operation, we found that the pericardium was adherent to the aneurysmal wall. Under cardiopulmonary bypass and beating heart, the heart was gently mobilized from the pericardium and loose adhesions were removed. An approximately 2  3-cm piece of the pericardium