Pseudoaneurysms of the heart.

Case 1: An 85-year-old man with a history of ischemic cardiomyopathy and recent reoperation coronary bypass surgery was noted on a routine follow-up echocardiogram to have a 25 25-mm fluid-filled extracardiac mass adjacent to the basal inferolateral wall of the left ventricle (Figure 1). Cardiac computed tomography (CT) identified the structure to be a pseudoaneurysm of a saphenous vein graft to an obtuse marginal branch of the left circumflex coronary artery. How should this patient be managed? Case 2: A 27-year old man with prior homograft aortic valve replacement developed recurrent endocarditis (Figure 2). Echocardiography noted a periaortic valvular fluid collection concerning for abscess or valvular dehiscence. However, Doppler signal to and from the fluid collection connecting to the left ventricular outflow tract also raised concern for pseudoaneurysm. Cardiac CT confirmed the structure to be a 37 32-mm pseudoaneurysm involving the left coronary cusp of a trileaflet homograft prosthetic aortic valve just below the takeoff of the implanted left main coronary artery. How should this patient be managed? Case 3: An 85-year-old woman with ischemic cardiomyopathy and myocardial infarction presented in cardiogenic shock (Figure 3). Angiography noted a chronically occluded right coronary artery. Echocardiogram identified a left ventricular ejection fraction of 25% with a basal inferior pseudoaneurysm. Cardiac magnetic resonance imaging (MRI) confirmed the presence of a transmural myocardial infarction with a pseudoaneurysm of the basal inferior and inferolateral wall. How should this patient be managed?