Case Report
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Cardiol. Apr 26, 2022; 14(4): 260-265
Published online Apr 26, 2022. doi: 10.4330/wjc.v14.i4.260
Uncommon post-infarction pseudoaneurysms: A case report
Hamid Jallal, Soufiane Belabes, Ali Khatouri
Hamid Jallal, Department of Cardiology, Military Hospital of Instruction Omar Bongo Ondimba, Libreville 204040, Gabon
Soufiane Belabes, Department of Radiology, Military Hospital of Instruction Omar Bongo Ondimba, Libreville 20404, Gabon
Ali Khatouri, Department of Cardiology, Military Hospital Avicenne, University Cadi Ayyad, Marrakech 40000, Morocco
Author contributions: Jallal H, Belabes S, and Khatouri A contributed equally to this work; Jallal H designed the case study, reviewed the literature, and wrote the manuscript; Khatouri A reviewed the literature and contributed to manuscript drafting; Belabes S performed the radiological analyses and interpreted the imaging findings; and all authors have read and approved the final manuscript.
Informed consent statement: Informed written consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: The authors declare that they have no conflicts of interest.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Hamid Jallal, MD, Assistant Professor, Department of Cardiology, Military Hospital of instruction Omar Bongo Ondimba, Street of Melene, Libreville 204040, Gabon. jalal-hamid@hotmail.com
Received: October 29, 2021
Peer-review started: October 29, 2021
First decision: December 27, 2021
Revised: January 5, 2022
Accepted: March 15, 2022
Article in press: March 15, 2022
Published online: April 26, 2022
Processing time: 171 Days and 4.8 Hours
Abstract
BACKGROUND

Mechanical complications are a rare presentation in chronic coronary syndromes, which have significantly decreased in the primary coronary intervention era. Incomplete rupture may occur, resulting in pseudoaneurysms (PANs). Early reperfusion decreases the risk of this complication. Echocardiography is the method of choice for diagnosis.

CASE SUMMARY

A 54-year-old female hypertensive patient, with a history of non-revascularized inferior and anterior ST-segment elevation myocardial infarction (MI) 4 years prior, was admitted to the cardiac unit of the hospital with complaints of abdominal pain and dyspnea lasting 2 mo. The patient was hemodynamically stable, and 12-lead electrocardiogram showed persistent ST elevation and Q wave in the inferior and apical regions. Transthoracic echocardiogram in the two-chamber view showed a narrow neck of a wide PAN in the distal apical left ventricular inferior wall. In addition, the apical four-chamber and subcostal views revealed a second bulky PAN of the apical wall separated from the first by a common organizing thrombus. Cardiac magnetic resonance imaging confirmed the coexistence of more than one PAN. The patient received conservative medical treatment, and surgery was scheduled for outside the country. The patient had worsening multiple organ failure and died 4 wk after presentation.

CONCLUSION

Multifocal PANs rarely occur in chronic MI. Attention should be paid to patients with pain and cardiovascular risk factors.

Keywords: Cardiac rupture, Myocardial infarction, Pseudoaneurysm, Echocardiogram, Case report

Core Tip: Multiple left ventricular pseudoaneurysms are a rare complication following myocardial infarction (MI), which can be diagnosed years after the infarction. This case highlights the ultimate importance of appropriate early reperfusion of MI and the role of echocardiography and multimodal imaging for the diagnostic assessment of this lethal condition.