Successful percutaneous closure of post myocardial infarction left ventricular ruptured pseudoaneurysm after failed surgical repair

Abstract

Left ventricular pseudoaneurysms occur as a consequence of left ventricular free wall rupture contained by pericardium. This clinical situation is an uncommon but lethal complication of acute myocardial infarction. Surgery usually is the preferred therapeutic option but is associated with significant perioperative risk. We present a case of successful percutaneous closure of left ventricular ruptured pseudoaneurysm post myocardial infarction in a patient who failed two previous surgical repairs. <Learning objective: Recently there has been some published experience regarding percutaneous closure of left ventricle pseudoaneurysm as an alternative to surgical repair in patients at high operative risk. To the best of our knowledge this is the first reported case that demonstrates successful percutaneous closure of ruptured pseudoaneurysm after failed surgical repairs.>.

Keywords: Acute myocardial infarction; Left ventricular free wall rupture; Left ventricular pseudoaneurysm.

Fig. 1

Transthoracic echocardiogram with color Doppler flow showing pericardial effusion and posterolateral left ventricular wall pseudoaneurysms with small myocardial tear (A). Coronary angiographic findings demonstrating a small obtuse marginal branch involved with severe disease (B). Right anterior oblique left ventricular angiogram revealing pseudoaneurysms (C). Transthoracic echocardiogram postsurgical patch repair (posterior wall) revealed no significant pericardial effusion (D).

Fig. 2

(A and B) Contrast enhanced computed tomography of the chest and abdomen demonstrated a large hematoma around the left side of the heart that had ruptured in the mediastinum and extended into upper abdomen and anterior abdominal wall.

Fig. 3

Left anterior oblique left ventricular angiogram revealing pseudoaneurysm with a narrow neck (A). Angiographic view demonstrates contrast flow into the pseudoaneurysm (B). Left ventriculogram shows occlusion of the pseudoaneurysm with use of a 14-mm Amplatzer occluder device (C and D).

Fig. 4

Contrast enhanced computed tomography of the chest 3 weeks post device closure revealed well-seated closure device without active leak of contrast through the device with remarkable reduction in the size of the pericardial hematoma (A). Significant reduction in the size of upper abdomen and anterior abdominal wall hematoma (B).