Introduction
Left ventricular (LV) pseudoaneurysm is characterized by cardiac rupture and encircled by a thin layer of pericardium without myocardial layer. It is sealed by organized thrombus. LV pseudoaneurysm is generally seen patients following myocardial infarction. Cardiac surgery, trauma and infection is the other etiology of LV pseudoaneurysm. The clinical presentation may vary such as mitral regurgitation, congestive heart failure, systemic embolism or ventricular arrhythmias. We report an idiopathic LV pseudoaneurysm presenting with multiple cerebral lacunar infarcts and successfully surgical treatment.
Case Report
A 69 years old man presented with multiple cerebral lacunar infarcts to neurology department. He is referred us for cardiac etiology of cerebral embolism. Patient was successfully evaluated. He had no history smoking, hypertension, diabetes mellitus, hyperlipidemia and family history for coronary artery disease. He had no chest pain, chest trauma or any infection. He only suffered from transient ischemic attacks. Electrocardiography(ECG) revealed normal sinus rhythm without pathological q waves. Echocardiography performed. Echocardiography demonstrated giant pseudoaneurysm typically with narrow neck and thrombus. Coronary angiography(CAG) performed to rule out coronary artery disease. CAG revealed a non-dominant right coronary artery with only atherosclerotic plaque in left anterior descending artery and circumflex artery. Left ventriculography demonstrated a pseudoaneurysm. Patient underwent to surgical treatment. Patient was successfully treated with using Teflon felt pledgets. Figure 1 demonstrates the echocardiographic and preoperative images of LV pseuodaneurysm. Patient was successfully discharged after surgery. There was no sign of cerebral ischemic attacks during the 9 month-follow-up period after surgery.
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