Left Ventricular and adjacent Right ventricular Pseudoaneurysms post
acute myocardial infarction communicating via a Ventricular Septal
Defect
Abstract
The rare but deadly post myocardial infarction (MI) mechanical
complications are categorized as ventricular free wall rupture,
ventricular septal rupture (VSD) and papillary muscle rupture in
decreasing order of incidence. The incidence of the mechanical
complications has been mitigated by early revascularization in recent
years but mortality remains high. The cardiac rupture if contained by
clot, scar and pericardium leads to a LV pseudoaneurysm that delays or
diminishes the fatal outcome. Mechanical complications and
pseudoaneurysm are recognized by echocardiography. We report a
previously unreported occurrence of a pseudoaneurysm involving the
adjacent walls of both the ventricles, LV basal and inferoseptal walls
and the adjacent right ventricular inferior wall (RV). The LV and RV
communicated via a hole in the pseudoaneurysmal wall. The
echocardiographic images initially showed the LV pseudoaneurysm bulging
into the RV rather than into the pericardium. The color Doppler showed
shunting through the LV pseudoaneurysm into the RV creating an unusual
VSD. The CT angiograms corroborated the echo findings. The LV
pseudoaneurysm had a tear in it and this led to bleeding not into
pericardium but into the adjacent RV pseudoaneurysm, hence creating a
very unusual VSD. Subsequently, our patient went for surgical repair of
pseudoaneurysm and the surgical findings confirmed the imaging findings
that there was a massive LV pseudoaneurysm from the inferior and
inferoseptal walls, the adjacent RV wall was involved with the
pseudoaneurysm and a communication between LV pseudoaneuysm sac and the
RV was seen. Such pathology has not been described in the past.