Pseudoaneurysm of left ventricle. Report of a case diagnosed by angiography and successfully repaired.

A patient with rupture of the left ventricular posterior wall with the formation of a pseudoaneurysm is reported. The underlying cause of the rupture was assumed to be myocardial infarction despite absent electro-cardiographic changes of myocardial necrosis and normal coronary arteriograms. The correct diagnosis was made by angiography and the aneurysm was successfully removed. False aneurysm of the left ventricle is extremely rare and the walls, devoid of myocardium and coronary arteries, are formed by fibrous tissue. Myocardial rupture occurs in 8 per cent of cases of myocardial infarction during the first week and is only rarely compatible with life (Gould, I960). In those rare instances of survival, adhesions between the layers of the pericardium have confined the bleeding to a limited space. The pericardial adhesions act as a protective mechanism and prevent death by cardiac tamponade. The present case is considered worthy of publication as being the only one correctly diagnosed before operation and in which the pseudoaneurysm was successfully removed. Case report A 5I-year-old married woman was admitted on I4 June 1971 with a history of severe chest pains of several hours' duration, radiating to the left arm and shoulder. The patient had been hypertensive for 7 years; she denied any previous history of chest pains. The admission electrocardiogram was normal; the SGOT 74 units, LDH II20 units, and there was a leucocytosis of 15,ooo. The chest x-ray showed a large cardiac silhouette probably due to left ventricular enlargement. During the first hospital days she continued to suffer from intermittent bouts of chest pain. Her temperature rose to 380C and during the following 5 weeks she had almost daily spikes to approximately 380C. No pericar-dial or pleural friction rub was heard. Numerous elec-trocardiograms showed mild ST elevation in the left praecordial leads V4 to V6, in the limb leads and aVL, with subsequent T wave inversion in these leads without abnormal Q waves. Despite the lack of definite electrocardiographic confirmation , it was felt that the patient had probably sustained a myocardial infarction and, as such, she was treated with anticoagulants. The persistent fever with daily spikes could not be explained on this basis alone; therefore, it was assumed that she was suffering from the postmyocardial infarction syndrome. Twenty days after admission, she was suddenly seized by severe pain localized to the left shoulder radiating to the back, accompanied by cold sweats. She transiently lost consciousness and became …