Dual presentation of a giant left ventricular pseudoaneurysm and true aneurysm.

W ith medical advances, mortality and morbidity rates associated with myocardial infarction (MI) have declined dramatically (1). Nevertheless, cardiogenic shock is the most common cause of death after an acute MI, followed by left ventricular (LV) rupture (2). A pseudoaneurysm, albeit rare (3), is more likely to rupture than is a true aneurysm and thus is a post-MI complication that warrants urgent surgery (4). It is usually the result of an infarction involving the entire thickness of the myocardium. A localized pericarditis develops, and the resulting adhesions between the visceral and parietal pericardium rupture, with extravasated blood being contained by the adherent pericardium. Th e aneurysmal wall contains dense fi brous tissue but lacks myocardial fi bers and coronary arteries. A true aneurysm, in contrast, consists of focal convex deformities of the heart, has wide communications between the aneurysmal cavity and left ventricle, contains myocardial fi bers, and is lined by the former endothelium (3). Th is area of thin myocardium subsequently moves dyskinetically (5). Figure 1 illustrates the two diff ering pathologies (3). Although transthoracic echocardiography (TTE) has been most studied in distinguishing pseudoaneurysms and true aneurysms (5), transesophageal echocardiography (TEE) is considered superior in the evaluation of pseudoaneurysms (6, 7). We report intraoperative management of a case presented for repair of a giant LV pseudoaneurysm and true aneurysm.