Harfoush A, Hayder O (2020) A Case of Left Ventricular Pseudo-Aneurysm. Int J Clin Cardiol 7:178.

Case Report | OPEN ACCESS DOI: 10.23937/2378-2951/1410178

A Case of Left Ventricular Pseudo-Aneurysm

Allam Harfoush* and Ousama Hayder

Resident Doctor, Department of Cardiovascular Diseases, Tishreen University Hospital, Syria

Left ventricular pseudo-aneurysm (LVPA) is an infrequent complication of MI, occurring of an average of 3-14 days following acute myocardial infarction [1]. Most common site is posterior region; however, it may bulge in the apical, lateral and inferior cardiac wall [1]. LVPA contains neither endocardium nor myocardium, whereas the pericardial adhesions and thrombus seal off myocardial rupture. This time-bomb is prone to rupture, thus urgent surgery is indicated once LVPA is diagnosed [2].

Although surgery is the key-management of LVPA, however, high risk LVPA surgeries including: Reduced LVEF, concomitant mitral regurgitation requiring mitral valve replacement [3] and other systemic co-morbidities, highlighted the role of medical management toward these group of patients.

Current literature presented numerous cases of conservative management of LVPA [4,5], with reasonable outcomes of a median of 3.8 years [6]. With a 50% mortality on medical therapy [7].


Left ventricular pseudo-aneurysm, Trans-thoracic echo, Coronary bypass graft, Coronary angiography, Diabetes mellitus, Hypertension


LVPA: Left Ventricular Pseudo-Aneurysm; TTE: Trans-Thoracic Echo; CABG: Coronary Bypass Graft; CAG: Coronary Angiography; DM: Diabetes Mellitus; HTN: Hypertension

Case Presentation

A 65-years-old gentle-man, heavily smoker (2 pocket per day).

Clinical history

Unknown history of HTN or DM, history of CVA 10 years ago (currently no motor abnormalities, presumably TIA), history of CAG 9 years ago for unknown complaint with normal coronary vessels flow (History of CVD).

Medication history

Aspirin 81 mg PO once daily, Bisoprolol 5 mg PO once daily, inhaler Ventolin when needed.

The patient was transferred from abroad hospital due to its medical costs, after performing a diagnostic CAG without PCI. However, the gentle-man did not have documents from his previous hospitalization but the videos of the CAG. Also, the patient has an undefined type of ACS due to the lack of information.

The patient was asymptomatic when he consults the cardiovascular department in Tishreen University Hospital.


Chest discomfort, orthopnea, palpitation, peripheral edema, jugular vein pressure, hepatojugular reflux: Within normal values.

NYHA II Dyspnea evolved over the last year.

Vital signs on admission:

BP: 120\80

Spo2: 95%

Pulse: 100 bpm

Respiratory rate: 17



1) Admission ECG: Ventricular tachycardia originating from the left ventricle (130 BPM) (Figure 1).

Figure 1: Admission ECG. View Figure 1

2) Department ECG (after administration of 300 mg I.V Amiodarone): NSR, 79 BPM, QS pattern on V1\V2, PRWP, LA enlargement pattern (Figure 2).

Figure 2: Department ECG. View Figure 2


Wide mediastinum, bulging at the apex (Figure 3).

Figure 3: Chest X- ray (CXR). View Figure 3

Transthoracic echo

1) Dilated LV, poor LV systolic function and LV remodeling (Figure 4A).

Figure 4A: Dilated LV, poor LV systolic function and LV remodeling. View Figure 4

2) Pseudo-aneurysm at the apex of the LV with abrupt transition from normal myocardium to the aneurysm, a ratio of the neck diameter to the maximum diameter < 50%, a narrow neck at the site of rupture and partial filling of the aneurysm with thrombus (Figure 4B).

3) SPE: Spontaneous Echo Contrast in the LV (Figure 4C).

Figure 4: B) Pseudo-aneurysm at the apex of the LV; C) Spontaneous echo contrast in the LV. View Figure 4B-C


Patient refused any medical intervention (surgery) after the recognition of the surgical risk of a combined CABG/LVPA Repair.

Patient was discharged after one week on a GDMT for Chronic Heart Failure, with a monthly follow-up in the cardiac ward. Unfortunately, patient died within one month of admission.


Surgical repair of post infarct left ventricular pseudo-aneurysm was associated with an acceptable surgical mortality rate [8]. However, conservative management in selected patients with increased surgical risk seems reasonable [9]. But until large studies confirm the favorable outcomes of medical management, the preferred approach would remain surgical management.


  1. Frances C, Romero A, Grady D (1998) Left ventricular pseudoaneurysm. J Am Coll Cardiol 32: 557-561.
  2. Faisal Inayat, Ali Raza Ghani, Iqra Riaz, Nouman Safdar Ali, Usman Sarwar, et al. (2018) Left ventricular pseudoaneurysm: An overview of diagnosis and management. J Investig Med High Impact Case Rep.
  3. Komeda M, David TE (1993) Surgical treatment of postinfarction false aneurysm of the left ventricle. J Thorac Cardiovasc Surg 106: 1189-1191.
  4. Jonathan Ludmir, Karan Kapoor, Praveen George, Jasjeet Khural, Brian Barr (2016) Left ventricular pseudoaneurysm following inferior myocardial infarction: A case for conservative management. Cardiol Res 7: 32-35.
  5. Daiki Ousaka, Naruki Obara, Megumi Fujiwara, Koushi Nakagawa, Akira Teraoka, et al. (2018) A case of conservative management for left ventricular giant pseudoaneurysm without ST segment changes. J Cardiol Cases 17: 165-170.
  6. R Moreno, E Gordillo, J Zamorano, C Almeria, JC Garcia-Rubira, et al. (2003) Long term outcome of patients with postinfarction left ventricular pseudoaneurysm. Heart 89: 1144-1146.
  7. Vlodaver Z, Coe JI, Edwards JE (1975) True and false left ventricular aneurysms. Propensity for the altter to rupture. Circulation 51: 567-572.
  8. Edvin Prifti, Massimo Bonacchi, Arben Baboci, Gabriele Giunti, Altin Veshti, et al. (2017) Surgical treatment of post-infarction left ventricular pseudoaneurysm: Case series highlighting various surgical strategies. Ann Med Surg 16: 44-51.
  9. Yeo TC, Malouf JF, Oh JK, Seward JB (1998) Clinical profile and outcome in 52 patients with cardiac pseudoaneurysm. Ann Intern Med 128: 299-305.


Harfoush A, Hayder O (2020) A Case of Left Ventricular Pseudo-Aneurysm. Int J Clin Cardiol 7:178.