A giant left ventricular pseudoaneurysm with severe mitral regurgitation after silent inferior myocardial infarction resulting in cardiogenic shock

A 60-year-old man presented with a two-week history of dyspnea and tachycardia at rest. Severe heart failure and findings of pulmonary edema without evidence of acute coronary syndrome were observed. Transthoracic echocardiography showed dilatation of the left ventricle (LV), severe mitral regurgitation, and a giant extra chamber, 11x14 cm in size, next to the posterior region of the LV, containing a massive thrombus. Coronary angiography performed on the same day showed total occlusion of the right coronary artery and a critical stenosis of the circumflex artery. An emergency operation was performed due to the sudden development of pulmonary edema and cardiogenic shock. The pseudoaneurysm was resected together with the thrombus, the defect in the LV myocardial wall was repaired, and mitral ring implantation and annuloplasty were performed. He was hospitalized for 22 days postoperatively due to heart failure and decreased oxygenation and was followed-up for three months.

Keywords: Aneurysm, false/surgery, myocardial infarction/complications; mitral valve insufficiency