Introduction

Myocardial rupture is usually rapidly fatal, however in this scenario, it fortuitously becomes limited by a pericardial adhesion. The pseudo-aneurysm wall consists only of the epicardium, pericardium and haematoma. In contrast, a left ventricular aneurysm has a wall of scarred myocardium. Left ventricular outpouching, usually located posterolaterally. It can calcify after many years.

Case Report

We report a 63-year old male patient with left ventricular posterior wall rupture contained by posterolateral pseudo-aneurysm with calcified thrombus. A coronary angiography is performed on the patient with a preliminary diagnosis of unstable angina and determined 90% stenosis in LAD a year ago. Primary PCI and drug-eluting stenting were undergone. The patient was admitted in our coronary care unit in a status of intubated with acute pulmonary edema on September 14. 2015 and was extubated two days later. Chest radiography revealed an enlarged mediastinal and cardiac silhouette (panel A). Computed tomography scan of the chest revealed a mediastinal parabolic contour (Panel B, video show 1). Transthoracic echocardiograms showed infero-basal hypokinesia and other akinetic segments, also confirmed a pseudoaneurysm which in neck 4 cm and in size 7.1×4.7cm extending from inferolateral to the anterolateral wall. EF was 20 % and ECC showed atrial fibrillation (Panel C). His last coronary angiography showed double vessel disease with total occlusion of the proximal left circumflex artery (Panel D, Video show 2,3). The patient underwent heart surgery. After opening the chest, it was observed that left ventricle dilated with a postero-lateral wall rupture. Dorr technique was used for endo-exclusion at an aneurysm by a path. The pseudoaneurysm was contained calcified thrombi.

The rupture was replaced with a pericardial patch and polypropylene running suture. AO-Diagonal and LAD grafting was performed (Panel E,F,G…, Video show 4). Cardiopulmonary bypass was finished without any complication. Unfortunately, he died due to severe bleeding the next day.