title: Surgical treatment of post-infarction left ventricular pseudoaneurysm: Case series highlighting various surgical strategies.
abstract: OBJECTIVE
  The left ventricular pseudoaneurysm (LVP) is rare, the surgical experience is limited and its surgical treatment remains still a challenge with an elevated mortality. Herein, it is presented a retrospective analysis of our experience with acquired post infarct LVP over a10-year period.
  
  
  METHODS
  Between January 2006 through August 2016, a total of 13 patients underwent operation for post infarct pseudoaneurysm of the left ventricle. There were 10 men and 3 women and the mean age was 61 ± 7.6 years. 4 patients presented acute LVP. Two patients had preoperative intraortic balloon pump implantation.
  
  
  RESULTS
  Various surgical techniques were used to obliterate the pseudoaneurysm such as direct pledgeted sutures buttressed by polytetrafluoroethylene felt, a Gore-Tex or Dacron patch, transatrial closure of LVP neck in submitral pseudoaneurysm, or linear closure in cases presenting associated postinfarct ventricular septal defect. Concomitant coronary artery bypasses were performed for significant stenoses in 12 patients, ventricular septal defect closure in 4 patients, mitral valve replacement in 3 and aortic valve replacement in 1 patient. Operative mortality was 30.8% (4 patients). Three of them were acute LVP. Three patients required the continuous hemodyalisis and 8 patients required intra-aortic balloon pump. At follow-up two deaths occurred at 1 and 3 years after surgery.
  
  
  CONCLUSIONS
  In conclusion, this study revealed that surgical repair of post infarct left ventricular pseudoaneurysm was associated with an acceptable surgical mortality rate, that cardiac rupture did not occur in surgically treated patients.
authors.affiliation: Division of Cardiac Surgery, University Hospital Center of Tirana, Tirana, Albania.
authors.forename: Edvin
authors.initials: E
authors.lastname: Prifti
authors.affiliation: Department of Cardiac Surgery, Policlinico Careggi, Florence, Italy.
authors.forename: Massimo
authors.initials: M
authors.lastname: Bonacchi
authors.affiliation: Division of Cardiac Surgery, University Hospital Center of Tirana, Tirana, Albania.
authors.forename: Arben
authors.initials: A
authors.lastname: Baboci
authors.affiliation: Department of Cardiac Surgery, Policlinico Careggi, Florence, Italy.
authors.forename: Gabriele
authors.initials: G
authors.lastname: Giunti
authors.affiliation: Division of Cardiac Surgery, University Hospital Center of Tirana, Tirana, Albania.
authors.forename: Altin
authors.initials: A
authors.lastname: Veshti
authors.affiliation: Division of Cardiac Surgery, University Hospital Center of Tirana, Tirana, Albania.
authors.forename: Aurel
authors.initials: A
authors.lastname: Demiraj
authors.affiliation: Division of Cardiac Surgery, University Hospital Center of Tirana, Tirana, Albania.
authors.forename: Merita
authors.initials: M
authors.lastname: Zeka
authors.affiliation: Division of Cardiac Surgery, University Hospital Center of Tirana, Tirana, Albania.
authors.forename: Edlira
authors.initials: E
authors.lastname: Rruci
authors.affiliation: Division of Cardiac Surgery, University Hospital Center of Tirana, Tirana, Albania.
authors.forename: Ervin
authors.initials: E
authors.lastname: Bejko
keywords: Left ventricular pseudoaneurysm; Myocardial infarction; Rupture free wall