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Case Reports
. 2025 Apr 2;30(7):103389.
doi: 10.1016/j.jaccas.2025.103389.

Percutaneous Closure of Postinfarct Left Ventricular Pseudoaneurysm After Surgical Patch Dehiscence

Bryan P Traynor  1 , Syed M Ali Hassan  2 , Thomas Attumalil  1 , Amr Gamal  1 , Yazeed Almalki  1 , Bradley Sarak  1 , Geraldine Ong  1 , Sami Alnasser  1 , Subodh Verma  2 , Neil P Fam  3
Affiliations
Case Reports

Percutaneous Closure of Postinfarct Left Ventricular Pseudoaneurysm After Surgical Patch Dehiscence

Bryan P Traynor et al. JACC Case Rep. .

Abstract

Background: Left ventricular free wall rupture is a life-threatening mechanical complication of ST-segment elevation myocardial infarction. In patients with a timely diagnosis, emergent surgical patch repair is the cornerstone of management; re-rupture, surgical patch dehiscence, and left ventricular pseudoaneurysm (LVPA) are potential late complications after surgery.

Case summary: A 72-year-old man presented with NYHA functional class III dyspnea 4 months after surgical patch repair. We report, to our knowledge, the first case of successful percutaneous closure of LVPA resulting from surgical patch dehiscence.

Discussion: LVPA after surgical repair is a serious late complication. Multimodality imaging and careful case planning allowed for successful device closure with excellent clinical outcome.

Take-home messages: Multimodality cardiac imaging is essential for accurate diagnosis and management of acute left ventricular free wall rupture and LVPA resulting from surgical patch dehiscence. Percutaneous closure of LVPA after surgical patch dehiscence is an effective and safe alternative to redo surgery.

Keywords: ST-segment elevation myocardial infarction; device closure; left ventricular free wall rupture; patch dehiscence; pseudoaneurysm.

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Conflict of interest statement

Funding Support and Author Disclosures Dr Fam has been a consultant for Edwards Lifesciences, Abbott, Cardiovalve, Medtronic, Tricares, and inQB8. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.

Figures

None
Graphical abstract
Figure 1
Figure 1
Percutaneous Closure of Post-Infarct Left Ventricular Pseudoaneurysm After Surgical Patch Dehiscence (A) Initial coronary angiogram showing proximal left circumflex artery occlusion (asterisk). (B, C) Cardiac CT of LVPA (red arrows) and dehisced surgical patch (blue arrow). (D) Left ventriculogram showing LVPA (red arrow). (E, H) Intraprocedural echocardiographic images showing LVPA before (red arrow) and after (asterisk) closure. (F, G) Fluoroscopic view showing device closure of LVPA (asterisk). CT = computed tomography; LVPA = left ventricular pseudoaneurysm.
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