Postinfarction left ventricular pseudoaneurysm with left-to-right shunt: Case report and review of the literature

Biventricular Rupture with Extracardiac Left-to-Right Shunt Complicating Acute Myocardial Infarction

“…Our literature search identified 16 articles, describing 17 patients (2 cases were reported by the same authors) [3,4,5,6,7,8,9,10,11,12,13,14,15,16]. For 2 cases, only the abstracts were available since the full texts were published in Japanese.…”

“…The majority of patients (n = 12; 71%) developed either cardiogenic shock (n = 4; 24%) [6,11,14,16] or the symptoms of congestive heart failure (n = 8; 47%) [3,5,7,8,9,10,13,15]. These events developed within days to several months after the infarction.…”

“…One patient died from cardiac arrest 10 days after surgery [11]. Six patients were treated conservatively due to a lack of symptoms and a relatively small left-to-right shunt [8,13], prohibitive surgical risk [9] or patient preference [7]. Two patients died from cardiogenic shock a few hours after admission and before planned surgery, respectively [6,14].…”

Left ventricular aneurysm or free wall covered rupture

“…Considering the silent cardiological anamnesis, the evidence of an OM occlusion, the unclear lesion of the apex and the presence of moderate pericardial effusion, the hypothesis of acute LVP was the most likely and, unfortunately, the most life-threatening despite there were some doubts concerning the time of the onset of the lesion (too early to be a pseudoaneurysm) and the size of the neck [1]. Considering the risk of a sudden pericardial rupture, we decided for urgent surgical treatment.…”

“…Early surgical approach is mandatory for the high risk of death due to the possibility of rupture or of malignant arrhythmia [1,5].…”