title: Surgical treatment of a giant postero-inferior left ventricular pseudoaneurysm causing severe mitral insufficiency and congestive heart failure.
abstract: BACKGROUND
  Left ventricular pseudoaneurysm caused by a transmural myocardial infarction is a fatal complication. Reliable diagnosis and on-time surgical intervention are significant for the patient's survival.
  
  
  RESULTS
  A 70-year-old diabetic man with a two-month earlier history of successful stent implantation on the proximal right coronary artery because of total occlusion was admitted to our institution with symptoms of congestive heart failure. Transthoracic echocardiogram showed severely decreased overall LV systolic function and a large aneurismal sac attached to the inferior surface of the left ventricle, moderate tricuspid regurgitation and severe mitral insufficiency. On transesophageal echocardiography examination and cardiac magnetic resonance imaging, the aneurismal cavity appeared to be entirely surrounded by thrombi. During the operation, a left ventricular postero-inferior pseudoaneurysm was observed to extend to the mitral annulus. Purse string suturing was used to reduce left ventricular volume, and the hole was closed with a Dacron patch. The patient was weaned from the CPB without any difficulty. The patient's postoperative period was uneventful, and his physical condition appeared to be very healthy (NYHA class I-II) after the first year.
  
  
  CONCLUSIONS
  Following a myocardial infarction, a careful preoperative examination and proper way to diagnose are essential on patients with nonspecific complains or asymptomatic. Despite the risk of high mortality, patients may survive when they are diagnosed and undergo surgery at the right time.
authors: Department of Cardiovascular Surgery, Institute of Cardiology, Istanbul University, Istanbul, Turkey.
authors: Erhan
authors: E
authors: Kansiz
authors: Ali Can
authors: AC
authors: Hatemi
authors: Aybala
authors: A
authors: Tongut
authors: Sadettin
authors: S
authors: Cohcen
authors: Ahmet
authors: A
authors: Yildiz
authors: Kadriye
authors: K
authors: Kilickesmez
authors: Cengiz
authors: C
authors: Celiker
mesh_terms: D000368:Aged; D017541:Aneurysm, False / Q000175:diagnosis / Q000209:etiology / Q000601:surgery*; D006348:Cardiac Surgical Procedures; D017023:Coronary Angiography; D017548:Echocardiography, Transesophageal; D006322:Heart Aneurysm / Q000175:diagnosis / Q000209:etiology / Q000601:surgery*; D006333:Heart Failure / Q000175:diagnosis / Q000209:etiology / Q000601:surgery*; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008944:Mitral Valve Insufficiency / Q000175:diagnosis / Q000209:etiology / Q000601:surgery*; D009203:Myocardial Infarction / Q000150:complications* / Q000175:diagnosis; D013536:Suture Techniques; D016896:Treatment Outcome