Uğur Canpolat Necla Özer Serdar Aksöyek Kenan Övünç

Uğur Canpolat Necla Özer Serdar Aksöyek Kenan Övünç

Department of Cardiology, Hacettepe University Faculty of Medicine, Ankara, Turkey

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A 55-year-old male with a history of anterior myocardial infarction (8 years ago) ad- mitted to our hospital with the complaint of fatigue. His physical examination was un- remarkable except for an apical 2/6 systolic murmur. The ECG showed sinus rhythm, 4 waYes and 6T segment eleYation at 9-5 leads ()ig. A). Chest ;-ray reYealed in- creased cardiothoracic ratio with rounded opacity silhouetting the left cardiac border (Fig. B). Transthoracic echocardiography (TTE) demonstrated a large apical left ven- tricular (/9) aneurysm and discontinuity (widest diameter .6 cm) in connection with an echo-free space, suggestive of a giant pseudoaneurysm (Fig. C). The maximum end- systolic pseudoaneurysmal diameters were 5.2x.5 cm. Color 'oppler showed Àow passage from the /9 into the pseudoaneurysm and pulsed 'oppler demonstrated sys- to-diastolic Àow through the false aneurysmal mouth (Fig. '). Coronary angiography



revealed a totally occluded left anterior descending ar- tery and ventriculography showed an apical aneurysm (Fig. E). Multidetector com- puted tomography (MDCT) showed nested true and gi- ant pseudoaneurysms (Fig.

F) and cardiac magnetic resonance imaging clearly demonstrated the communi- cation to the /9 and the si]e of the pseudoaneurysm with a small thrombus. Surgery con¿rmed the diagnosis, and endoaneurysmorrhaphy of the myocardial hole was per- formed via pericardial patch.

However, recurrence of the pseudoaneurysm occurred two months after surgery (Figs. G and H). The patient declined to undergo a second operation and he was asymp- tomatic at 7 years follow-up with no enlargement of the pseudoaneurysm. Although acute free intrapericardial rupture usually causes cardi- ac tamponade and death, /9 pseudoaneurysm formation may be a very uncommon

¿nding in chronic myocar- dial infarction.

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