left ventricular pseudoaneurysm is a rare condition because in most instances ventricular free - wall rupture leads to fatal pericardial tamponade .
rupture of the free wall of the left ventricle is a catastrophic complication of myocardial infarction , occurring in approximately 4% of patients with infarcts , resulting in immediate collapse of the patient and electromechanical dissociation . in rare cases
the rupture is contained by pericardial and fibrous tissue , and the result is a pseudoaneurysm .
the left ventricular pseudoaneurysm contains only pericardial and fibrous elements in its wall - no myocardial tissue .
because such aneurysms have a strong tendency to rupture , this disorder may lead to death if it is left surgically untreated .
in this case report , we present a patient who underwent successful repair of a left ventricular pseudoaneurysm , which followed a myocardial infarction that was caused by occlusion of the left circumflex coronary artery . although repair of left ventricular pseudoaneurysm is still a surgical challenge , it can be performed with acceptable results in most patients .
left ventricular pseudoaneurysm ( lvp ) is a very rare condition because in most instances ventricular free - wall rupture leads to fatal pericardial tamponade ( 1 ) .
myocardial infarction ( mi ) is the most common cause of false aneurysms of the left ventricle ( 2 , 3 ) .
rupture of the free wall of the left ventricle is most often catastrophic complication of mi , occurring in approximately 4% of patients with infarcts resulting in immediate collapse of the patient ( 4 ) .
in addition , it may be associated with mitral valve replacement , previous unsuccessful ventriculotomy , trauma , inflammation , tumor invasion , and apical venting ( 5 ) .
lvp develop when pericardium surrounds the rupture in combination with thrombus and inflammation and thus prevents the development of a hemopericardium .
it contains only pericardial and fibrous elements in its wall , with no myocardial tissue .
lvp may remain silent unless it gives rise to hemopericardium , once the hemopericardium develops , it may result in cardiac tamponade and sudden death ( 6 ) . because such aneurysms have a strong tendency to rupture , this disorder may lead to death if it is left surgically untreated ( 7 ) . in this case report , we present a patient who underwent successful repair of a lvp , which followed a myocardial infarction that was caused by occlusion of the left circumflex coronary artery .
a 57-year - old male patient was admitted to another hospital with chest pain that had started 7 days previously . during coronary angiography ,
selective left coronary injection with showed occlusion of the distal left circumflex artery.(figure 1 ) .
the ventriculography is shown in figure 2 , demonstrating what appears to be an aneurysm .
coronary angiography : occlusion of the left circumflex artery in its distal portions ventriculography : left ventricular pseudoaneurysm in the inferobasal wall .
echocardiography showed lv dysfunction with an ejection fraction of 0.35 and akinesia of the inferior wall . on this echo
it became apparent that the patient had a large lvp measuring around 5x5 cm on the inferobasal wall , communicating through a narrow neck of 2,2 cm in diameter ( figure 3 ) .
echocardiography : large left ventricular pseudoaneurysm in the inferobasal wall intraoperatively , a large non ruptured posterior pseudoaneurysm was seen to communicate through a the neck which measured 2x3 cm in diameter .
the lvp was resected , and the defect in the inferior wall of the left ventricle repaired with a dacron patch ( figure 5 ) .
intraoperative finding : opened left ventricular pseudoaneurysm rapair of defect with dacron patch the postoperative course was uneventful .
an echocardiogram on the third postoperative day showed improvement in ejection fraction to 0.50 , and the repair site was clearly seen ( figure 6 ) .
follow - up visit , the patient was in nyha class i. postoperative echocardiography after pseudoaneurysm repair
lvp is rare with a prevalence of 0.05% ( 8) , and usually develops in patients having their first mi ( 9 ) .
inferior and posterolateral mi are responsible for 82% of the lvp developing after mi . usually , lvp is located inferoposterior due to occlusion of the circumflex artery , but it can be found in the apical region due to anterior mi .
mi rarely results in lvp formation because ruptures in the anterior wall generally leads to hemopericardium or tamponade ( 10 , 11 ) .
lvp may remain clinically silent and be discovered during routine clinical investigations , or can present with chest pain , congestive heart failure , arrhythmias , or embolism .
the development of heart failure is related to an non contracted and dyskinetic region , with dilatation of the pseudoaneurysm sac during systole .
cardiac catheterization with left ventriculography has been the gold standard for establishing the diagnosis , and is necessary before surgery to evaluate the need for concomitant bypass grafting ( 13 ) .
there is strong indication for surgery in lvp ( 15 ) since untreated pseudoaneurysm have a 30% to 45% risk of rupture ( 16 ) .
the general consensus is that surgery is indicated for all patients as soon as the diagnosis is established , unless the surgical risk is prohibitive .
if a pseudoaneurysm is diagnosed within 2 to 3 months after mi , emergency surgery should be performed because of the high risk of rupture .
if the diagnosis is made years after mi , the necessity and urgency of surgery depends on the symptoms .
resection , if necessary , combined with bypass grafting is the treatment of choice in symptomatic patients , but the operative risk is high due ( 7%29% ) to the underlying cardiac pathologies ( 17 ) .
 introduction : left ventricular pseudoaneurysm is a rare condition because in most instances ventricular free - wall rupture leads to fatal pericardial tamponade . 
 rupture of the free wall of the left ventricle is a catastrophic complication of myocardial infarction , occurring in approximately 4% of patients with infarcts , resulting in immediate collapse of the patient and electromechanical dissociation . in rare cases 
 the rupture is contained by pericardial and fibrous tissue , and the result is a pseudoaneurysm . 
 the left ventricular pseudoaneurysm contains only pericardial and fibrous elements in its wall - no myocardial tissue . because such aneurysms have a strong tendency to rupture , this disorder may lead to death if it is left surgically untreated.case report : in this case report , we present a patient who underwent successful repair of a left ventricular pseudoaneurysm , which followed a myocardial infarction that was caused by occlusion of the left circumflex coronary artery . although repair of left ventricular pseudoaneurysm is still a surgical challenge , it can be performed with acceptable results in most patients . 
Introduction:
Case report:
1. INTRODUCTION
2. PATIENT AND METHOD
3. DISCUSSION