Spontaneous closure of a large left ventricular pseudoaneurysm.

A 52-year-old nondiabetic, normotensive male presented with dyspnea on exertion NYHA class II of 6 months duration. He suffered an anterior wall myocardial infarction, 3 years back. His clinical examination was unremarkable. ECG showed normal sinus rhythm and qs pattern in V3–V6 chest leads, and I, aVL limb leads. Two-dimensional echocardiography revealed akinetic and thinned out anterior wall and septum, and left ventricle (LV) ejection fraction of 0.25. Coronary angiography revealed 70% discrete stenosis of mid left anterior descending artery; rest of the coronaries were normal. Left ventriculogram showed akinetic antero-lateral, apical and inferior wall, and an ejection fraction of 0.25. Around the antero-lateral wall and apex of LV, there was a non-opacified mass that was moving along with heart movements, suggestive of occluded LV pseudoaneurysm (Fig. 1, Video 1). Computed tomography image showed an 89 mm × 33 mm multilayered thrombosed, calcified hypoattenuating LV pseudoaneurysm around the anterior wall and apex of the heart (Fig. 2). There was no communication between the pseudoaneurysm and the LV cavity. He was managed with standard medical treatment, and remained asymptomatic at 5-year follow-up.

Fig. 1

Left ventriculogram in right anterior oblique 30° view showed large nonopacified pseudoaneurysm around the apex and antero-lateral wall of LV (outlined with white arrows).

Fig. 2

Computed tomographic axial (a) and coronal (b) view of heart showing thinned out dilated LV apex with multilayered, calcified, hypoattenuating, thrombosed LV pseudoaneurysm.

A 52-year-old nondiabetic, normotensive male presented with dyspnea on exertion NYHA class II of 6 months duration. He suffered an anterior wall myocardial infarction, 3 years back. His clinical examination was unremarkable. ECG showed normal sinus rhythm and qs pattern in V3–V6 chest leads, and I, aVL limb leads. Two-dimensional echocardiography revealed akinetic and thinned out anterior wall and septum, and left ventricle (LV) ejection fraction of 0.25. Coronary angiography revealed 70% discrete stenosis of mid left anterior descending artery; rest of the coronaries were normal. Left ventriculogram showed akinetic antero-lateral, apical and inferior wall, and an ejection fraction of 0.25. Around the antero-lateral wall and apex of LV, there was a non-opacified mass that was moving along with heart movements, suggestive of occluded LV pseudoaneurysm (Fig. 1, Video 1). Computed tomography image showed an 89 mm × 33 mm multilayered thrombosed, calcified hypoattenuating LV pseudoaneurysm around the anterior wall and apex of the heart (Fig. 2). There was no communication between the pseudoaneurysm and the LV cavity. He was managed with standard medical treatment, and remained asymptomatic at 5-year follow-up.

LV pseudoaneurysm is a late mechanical complication of myocardial infarction, as was present in the index case. The obliterated sac around the LV could have been a pseudoaneurysm with narrowed neck, which got thrombosed over a period of time. Spontaneous closure of a small, iatrogenic pseudoaneurysm following cardiac intervention has been reported2, 3; however, closure of such a large pseudoaneurysm as in index case has not been reported in English literature.

Conflicts of interest

The authors have none to declare.