A case of myocardial infarction and left ventricular pseudo-false aneurysm perforating the right ventricle

Excerpt

We describe a case of left ventricular (LV) pseudo-false aneurysm perforating the right ventricle (RV), which is a very uncommon complication of myocardial infarction (MI). An 88-year-old woman was referred to our hospital because of complete atrioventricular block. She was drowsy, her heart rate was 27 beats/min, and her blood pressure was 90/70 mmHg. A grade of II/VI pansystolic murmur was audible at the lower sternal border. Echocardiographic study revealed an aneurysm on the inferoseptum and a large (30 mm) defect between the inferoseptal wall and the aneurysm (Fig. 1a). A color Doppler image showed shunt flows passing from a large defect of inferoseptal myocardium and the aneurysmal pouch to the RV (Fig. 1b, c). Coronary arteriography was performed and the proximal right coronary artery (RCA) was occluded. The left coronary arteries were normal and percutaneous coronary intervention of the RCA was not performed. On the basis of the initial laboratory examination findings (creatine kinase 563 U/L, creatine kinase MB 29.1 ng/mL, troponin I 49.31 ng/mL), she was diagnosed with a perforation of an LV pseudo-false aneurysm into the RV following the subacute phase of an inferior MI. Temporary pacing and intra-aortic balloon pumping were started, and prompt surgical repair of the LV pseudo-false aneurysm was considered. However, her operative risk was high and her family desired conservative management. She died 10 days after admission as a result of multi-organ failure.

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