Long-term Survival of A Patient with Asymptomatic Left Ventricular Pseudoaneurysm after Acute Myocardial Infarction

An 82 years old man developed a left ventricular pseudoaneurysm after acute myocardial infarction when he was 72 years old. Coronary angiography showed left main and triple-vessel coronary artery disease. On left ventriculography, a tubular-like pseudoaneurysm was demonstrated that originated from the basal inferoposterior wall of the left ventricle. He underwent coronary artery bypass surgery with no plication of the pseudoaneurysm because the surrounding tissues of pseudoaneurysm were all necrotic. The most recent follow-up transthoracic echocardiography revealed a hypokinetic basal inferior wall, impaired LV contraction with an ejection fraction of 44%, and an inferoposterior wall pseudoaneurysm. The patient was doing well more than 10 years after the myocardial infarction. The prognosis might be determined by the organized thrombi, aggressive pharmacologic treatment, and coronary artery bypass surgery. Although our patient has survived for more than 10 years with a nonsurgically treated post-infarction LV pseudoaneurysm, we could not provide an evidence to support that conservative therapy is enough for every patient with a post-infarction pseudoaneurysm. (J Intern Med Taiwan 2012; 23: 442-448)