LAUSR

A 75-year-old gentleman presented with increasing exertional chest pain for the past 2 weeks. He reported history of myocardial infarction 12 years earlier. Cardiac catheterization had not been performed at that time. Electrocardiogram showed old inferior myocardial infarction. Chest X-ray showed cardiomegaly along with outpouching of left cardiac border (Fig. 1a). Echocardiogram showed abrupt myocardial discontinuity of inferolateral wall leading to a large thrombus-containing cavity indicative of left ventricular pseudoaneurysm (Supplement Video 1). Chest CT scan confirmed the presence of the giant pseudoaneurysm of the inferolateral wall of left ventricle containing large amounts of thrombus (Fig. 1b, Supplement Video 2). Coronary angiography showed severe three-vessel disease with poor distal run-off. Patient’s symptoms improved with anti-ischemic medications. Upon discussing the risk of surgery, the patient opted to pursue medical therapy and he was discharged on warfarin treatment for preventing the occurrence of potential thromboembolic events. Small percentage of left ventricular pseudoaneurysms becomes chronic. The risk of rupture is not as high as historical reports by sporadic lethal cases of left ventricular pseudoaneurysms. As more chronic cases are being diagnosed through advanced cardiac imaging techniques, more and more physicians choose to closely follow their patients without a need for urgent surgical intervention [1]. Unlike acute pseudoaneurysms that have higher tendency to rupture, conservative approach with optimizing heart failure treatment and consideration of anticoagulation could be an option in chronic cases who are deemed to be at high risk for intervention [2].