Left ventricular pseudoaneurysmectomy in patient without hemodynamic instability: A case report

Left ventricular aneurysm (LVA) has been recognized as a serious complication of myocardial infarction (MI), which can lead to serious morbidity or death. The reported incidence of LVA after MI is 10%–35% and has declined, primarily due to treatment with coronary angioplasty performed in the acute phase of the event. A LVA is classified as true or false. A true LVA involves the entire wall thickness of the left ventricle, usually in the setting of a large transmural infarct, most commonly found in the anterior and/or apical wall. A false LVA or pseudoaneurysm occurs after myocardial rupture post-MI, mostly 5–10 days after left circumflex artery occlusion (LCX), and is contained by adherent pericardium or fibrous scar tissue. False LVA arises commonly from the base of the inferior and/or lateral walls. The diameter of LVA varies from 1 to 8 cm. Aneurysms can be asymptomatic or cause heart failure. Several treatment methods are currently available for LVP, including drug therapy and surgical intervention. The majority of true LVA is managed conservatively, while
LV pseudoaneurysms are commonly treated with urgent surgery because of the high risk of rupture. The most important surgical indication is the size of the aneurysm (>3 cm), while drug therapy can be considered in asymptomatic patients with a small one (<3 cm).