A 60-year-old man with no known relevant medical history was admitted to the Emergency Department for fatigue and dyspnea with one month of evolution. ECG revealed inverted T waves in DII, DIII, aVF, V5 and V6 and pathologic Q waves in DII, DIII and aVF. Laboratory tests showed a NT-pro BNP of 2897pg/mL. Heart failure was diagnosed with a probable ischemic etiology (old inferior myocardial infarction) and the patient was admitted to the cardiology ward. The transthoracic echocardiography revealed a severe depression of ejection fraction, a severe mitral regurgitation and a sacculiform image at the level of the infero-posterior wall of the left ventricle, with expansion in systole and an apparent loss of wall thickness, suggesting pseudoaneurysm (Figs. 1 and 2, Video 1). Cardiac MRI confirmed that it was a pseudoaneurysm of the infero-posterior wall of the left ventricle (Fig. 3, Video 2).
Left ventricular pseudoaneurysm is a rare mechanical complication of myocardial infarction resulting from myocardial rupture contained by the adjacent pericardium and is associated with high mortality.1 In the present case, the patient had a pseudoaneurysm with an indefinite evolution time, was submitted to cardiac surgery to exclude the pseudoaneurysm and mitral valve replacement and presented a good clinical evolution, having slight limitation of physical activity (class II of the New York Heart Association Functional Classification).
