Rupture of giant left ventricular pseudoaneurysm: a case report and literature review

Abstract

Left ventricular pseudoaneurysm is defined as a rupture of the free wall of the left ventricle contained by adjacent pericardial tissue. This rare complication is most commonly seen following myocardial infarction, trauma, or infection. Surgery is often warranted to avoid progression to spontaneous rupture, potentially leading to cardiac tamponade and death. Cardiac magnetic resonance imaging is the modality of choice for left ventricular morphological and functional characterization. The precise distinction between pseudoaneurysm and true aneurysm is important, as management and prognosis vary considerably between these two entities. We report a rare case of a 34-year-old male patient with infective endocarditis and left ventricular pseudoaneurysm (PA). The patient’s symptoms are fever and cough continuously for 5 days before admission, no treatment. The patient has chest pain and is very tired. Echocardiography showed an aneurysm of the left ventricle in the lateral wall with a size of 40x27mm. Sputum culture showed Aspergillus flavus. Covid-19 test negative. After 4 days of admission, he had a cardiac arrest and lost consciousness. Immediately, he was indicated for emergency surgery to patch the heart. After surgery, the patient underwent coronary computed tomography to exclude myocardial infarction. Magnetic resonance imaging of the aneurysm showed a giant PA measuring 66x48x36mm. The treatment of choice for this rare condition is surgical removal of the PA, and patching the perforation, which helps the patient to recover gradually. In this case, early diagnosis and prompt surgical intervention lead to a good prognosis