Late left ventricular pseudoaneurysm formation following subacute myocardial infarction

We describe a patient with a subacute inferior myocardial infarction who developed a pseudo–aneurysm more than 18 days after the acute event. This is an unusual case with three different complications of a myocardial infarction: Firstly, ventricular rupture is usually the result following transmural myocardial infarction without reperfusion. However, coronary angiography confirmed reperfusion after late thrombolysis in this patient. The subacute rupture could potentially be caused or aggravated by the late thrombolysis. Secondly, this patient developed a mural apical thrombus in a non-infarcted region. It seems most likely that the new infarct caused a low flow state which enhanced thrombus formation. Against expectations, this developed at the apex rather than the site of the recent inferior wall myocardial infarction. Thirdly, we documented the development of a pseudo–aneurysm more than 18 days after the myocardial infarction. This complication is rarely seen at this stage after a myocardial infarction, as most pseudo–aneurysms are formed within 7 days after a myocardial infarction. We have beautifully visualised the apical thrombus and pseudo–aneurysm with echocardiography. This report shows that serial echocardiography is a very useful tool in evaluating the patientʹs clinical and cardiac status in the period after a myocardial infarction.