Left ventricular pseudoaneurysm after coronary artery bypass and valve replacement for post-infarction mitral regurgitation.

Most left ventricular inferior wall aneurysms are classified as false, and they have a narrow neck and exhibit rapid flow. Inferior wall pseudoaneurysms that develop soon after primary percutaneous intervention and coronary artery bypass grafting for acute myocardial infarction are rare. We report the case of a 64-year-old man who had a wide-necked left ventricular inferior wall pseudoaneurysm that developed soon after surgery for an acute myocardial infarction and post-infarction mitral regurgitation that occurred as a mechanical complication. The surgery consisted of coronary artery bypass grafting and mitral valve replacement. After the surgery, congestive heart failure developed. At reoperation, we found a large pseudoaneurysm that had caused tearing of the chordae tendineae of the posterior mitral leaflet and scarring around the inferior wall defect. The inferior wall defect had formed the wide neck of the left ventricular pseudoaneurysm. We excised the pseudoaneurysm and the scar tissue and attached a small patch to the defect such that it decreased the left ventricular dimension. Our patient survived the surgery and recovered completely. In patients with acute myocardial infarction, left ventricular pseudoaneurysms can occur soon after coronary artery bypass grafting and surgery for a complication such as mitral valve regurgitation. When a large portion of the left ventricular wall is infarcted and its removal would create a smaller cavity with compromised output, we recommend ventricular reconstruction by patch placement.